Provider Demographics
NPI:1952977514
Name:MASLOW, TONIA ANN (RDTN)
Entity type:Individual
Prefix:MRS
First Name:TONIA
Middle Name:ANN
Last Name:MASLOW
Suffix:
Gender:F
Credentials:RDTN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21311 IRISH AVE N
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-9554
Mailing Address - Country:US
Mailing Address - Phone:651-368-4816
Mailing Address - Fax:
Practice Address - Street 1:21311 IRISH AVE N
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-9554
Practice Address - Country:US
Practice Address - Phone:651-368-4816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN726291136A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered