Provider Demographics
NPI:1497975007
Name:SHAFFER, TAMARA L (RD)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:L
Last Name:SHAFFER
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 1:123 SOUTH 27TH STREET
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-4200
Mailing Address - Country:US
Mailing Address - Phone:406-247-3350
Mailing Address - Fax:406-247-3389
Practice Address - Street 1:123 SOUTH 27TH STREET
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-4200
Practice Address - Country:US
Practice Address - Phone:406-247-3350
Practice Address - Fax:406-247-3389
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00000679133V00000X
MT44387133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered