Provider Demographics
NPI:1326154105
Name:NABOZNY, TIFFANY R (RD LD)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:R
Last Name:NABOZNY
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 1:9374 LARK MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-9375
Mailing Address - Country:US
Mailing Address - Phone:513-336-6235
Mailing Address - Fax:
Practice Address - Street 1:5540 BOOMER RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45247-7923
Practice Address - Country:US
Practice Address - Phone:513-477-4270
Practice Address - Fax:859-586-7017
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4891133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered