Provider Demographics
NPI:1134220353
Name:DOIRON TARDIF, JOSEE (RD, LD)
Entity type:Individual
Prefix:
First Name:JOSEE
Middle Name:
Last Name:DOIRON TARDIF
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 RIVIERA STREET
Mailing Address - Street 2:
Mailing Address - City:DSL OF DRUMMOND
Mailing Address - State:NEW BRUNSWICK
Mailing Address - Zip Code:E3Y 2L3
Mailing Address - Country:CA
Mailing Address - Phone:506-473-3187
Mailing Address - Fax:
Practice Address - Street 1:140 ACADEMY STREET
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-0151
Practice Address - Country:US
Practice Address - Phone:207-768-4354
Practice Address - Fax:207-768-4373
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDI758133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMT0593Medicare ID - Type Unspecified