Provider Demographics
NPI:1205616570
Name:MUECKE, TANYA (MS, RDN, LDN)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:MUECKE
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 DE VICTOR PL
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-1705
Mailing Address - Country:US
Mailing Address - Phone:540-808-8808
Mailing Address - Fax:
Practice Address - Street 1:1132 DE VICTOR PL
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-1705
Practice Address - Country:US
Practice Address - Phone:540-808-8808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004769133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered