Provider Demographics
NPI:1225688013
Name:LEEPER, TAMMY J (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:J
Last Name:LEEPER
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4107 E SHANNON ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-7740
Mailing Address - Country:US
Mailing Address - Phone:480-390-2655
Mailing Address - Fax:
Practice Address - Street 1:4107 E SHANNON ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-7740
Practice Address - Country:US
Practice Address - Phone:480-390-2655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered