Provider Demographics
NPI:1578664785
Name:FORTMAN, LINDSAY SUZANNE (MS, RDN, CDCES)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:SUZANNE
Last Name:FORTMAN
Suffix:
Gender:F
Credentials:MS, RDN, CDCES
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:SUZANNE
Other - Last Name:KASEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1145 SHELTER LN
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-5025
Mailing Address - Country:US
Mailing Address - Phone:517-449-6005
Mailing Address - Fax:
Practice Address - Street 1:819 N. SHIAWASSEE STREET
Practice Address - Street 2:DIABETES AND NUTRITION EDUCATION
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867
Practice Address - Country:US
Practice Address - Phone:989-720-7081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI986458133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered