Provider Demographics
NPI:1205478880
Name:BROWN, TIFFANY (MS, RD)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD
Mailing Address - Street 1:7379 HARMON LN
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:49428-8716
Mailing Address - Country:US
Mailing Address - Phone:616-826-2460
Mailing Address - Fax:
Practice Address - Street 1:5838 METRO WAY SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-9619
Practice Address - Country:US
Practice Address - Phone:608-821-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-15
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI86050429133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered