Provider Demographics
NPI:1164734661
Name:CHRISTOPHERSON, TANYA ROSE (RD, LD)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:ROSE
Last Name:CHRISTOPHERSON
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 COURT AVE S
Mailing Address - Street 2:PINE MEDICAL CENTER
Mailing Address - City:SANDSTONE
Mailing Address - State:MN
Mailing Address - Zip Code:55072-5120
Mailing Address - Country:US
Mailing Address - Phone:320-245-2211
Mailing Address - Fax:
Practice Address - Street 1:109 COURT AVE S
Practice Address - Street 2:PINE MEDICAL CENTER
Practice Address - City:SANDSTONE
Practice Address - State:MN
Practice Address - Zip Code:55072-5120
Practice Address - Country:US
Practice Address - Phone:320-245-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered