Provider Demographics
NPI:1437922093
Name:TYFFANIE AMMETER NUTRITION PLLC
Entity Type:Organization
Organization Name:TYFFANIE AMMETER NUTRITION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TYFFANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:AMMETER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, CSG, CDN
Authorized Official - Phone:719-404-6276
Mailing Address - Street 1:PO BOX 830
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:10925-0830
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:29 RUMSEY RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD LAKE
Practice Address - State:NY
Practice Address - Zip Code:10925-2572
Practice Address - Country:US
Practice Address - Phone:719-404-6276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center