Provider Demographics
NPI:1558803569
Name:WARD, TAMARA (RD, CSO, LD)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:WARD
Suffix:
Gender:F
Credentials:RD, CSO, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7053 BLACKHAWK DR
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:OH
Mailing Address - Zip Code:45152-8964
Mailing Address - Country:US
Mailing Address - Phone:513-509-1593
Mailing Address - Fax:
Practice Address - Street 1:7053 BLACKHAWK DR
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:OH
Practice Address - Zip Code:45152-8964
Practice Address - Country:US
Practice Address - Phone:513-509-1593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-08
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.6244133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered