Provider Demographics
NPI:1376902080
Name:ALVORD, TAMMY (BSHN, CM)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:ALVORD
Suffix:
Gender:F
Credentials:BSHN, CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2898 COUNTY ROAD 28
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IN
Mailing Address - Zip Code:46793-9426
Mailing Address - Country:US
Mailing Address - Phone:260-927-5368
Mailing Address - Fax:
Practice Address - Street 1:115 W 5TH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-1740
Practice Address - Country:US
Practice Address - Phone:260-927-5368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education