Provider Demographics
NPI:1477755098
Name:LINDBERG, TAMMY JANE (RD)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:JANE
Last Name:LINDBERG
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 MAGNA VISTA CT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-2548
Mailing Address - Country:US
Mailing Address - Phone:210-481-5097
Mailing Address - Fax:210-292-7826
Practice Address - Street 1:2200 BERGQUIST DR STE 1
Practice Address - Street 2:ATTN CREDENTIALS (CMC)
Practice Address - City:LACKLAND A F B
Practice Address - State:TX
Practice Address - Zip Code:78236-9908
Practice Address - Country:US
Practice Address - Phone:210-292-5020
Practice Address - Fax:210-292-7826
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT80428133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT80428OtherLICENSED DIETITIAN