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NPI Code Detail

MEDICARE: TIFFANY LAUREN WHITE RD, LDN

MEDICARE:   TIFFANY LAUREN WHITE  RD, LDN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian164.007666IL

General Provider Information

NPI Number : 1255899365
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY LAUREN WHITE RD, LDN
Provider Business Mailing Address
First Line : 1150 W 15TH ST UNIT 302
Second Line :
City : CHICAGO
State : IL
Zip : 60608-3688
Country : US
Telephone Number : 708-262-2169
Fax Number :
Provider Business Practice Location Address
First Line : 922 W DIVERSEY PKWY
Second Line :
City : CHICAGO
State : IL
Zip : 60614-1416
Country : US
Telephone Number : 773-529-0057
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2019
Last Update Date : 03/07/2019

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Directions to “ TIFFANY LAUREN WHITE RD, LDN” Practice Location

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