Provider Demographics
NPI:1982044905
Name:PAVEK, AYN TANYA (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:AYN
Middle Name:TANYA
Last Name:PAVEK
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:MISS
Other - First Name:AYN
Other - Middle Name:TANYA
Other - Last Name:REDFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1920 GRANT ST NW
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-4831
Mailing Address - Country:US
Mailing Address - Phone:507-334-2085
Mailing Address - Fax:
Practice Address - Street 1:1920 GRANT ST NW
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-4831
Practice Address - Country:US
Practice Address - Phone:507-334-2085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-05
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2662133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered