Provider Demographics
NPI:1679190938
Name:MPAGI, TIRZAH CHRISTINE
Entity Type:Individual
Prefix:
First Name:TIRZAH
Middle Name:CHRISTINE
Last Name:MPAGI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4590 US ROUTE 50
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45118-9061
Mailing Address - Country:US
Mailing Address - Phone:513-519-7383
Mailing Address - Fax:
Practice Address - Street 1:9154 PORT UNION RIALTO RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-2935
Practice Address - Country:US
Practice Address - Phone:513-519-7383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-02
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.08953133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered