Provider Demographics
NPI:1720188360
Name:SUMMERS, TAMMY L (RD (DIETITIAN))
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:L
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:RD (DIETITIAN)
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:L
Other - Last Name:DUQUAINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 13508
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54307-3508
Mailing Address - Country:US
Mailing Address - Phone:920-433-0111
Mailing Address - Fax:920-433-8765
Practice Address - Street 1:835 S VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3526
Practice Address - Country:US
Practice Address - Phone:920-433-0111
Practice Address - Fax:920-433-8765
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1652-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered