Provider Demographics
NPI:1386628782
Name:ALTIZER, SANDY (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:SANDY
Middle Name:
Last Name:ALTIZER
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 SILVER CLOUD LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1211
Mailing Address - Country:US
Mailing Address - Phone:865-470-3602
Mailing Address - Fax:
Practice Address - Street 1:9314 PARK WEST BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4330
Practice Address - Country:US
Practice Address - Phone:865-694-9676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1427133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3241628Medicare ID - Type Unspecified