Provider Demographics
NPI:1598189912
Name:RICCI, TIFFANY (RDN, LD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:RICCI
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4218 LONG RIDER TRL
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59106-9402
Mailing Address - Country:US
Mailing Address - Phone:907-750-9356
Mailing Address - Fax:
Practice Address - Street 1:4218 LONG RIDER TRL
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59106-9402
Practice Address - Country:US
Practice Address - Phone:907-750-9356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-05
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT87192133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered