Healthcare Provider Details

I. General information

NPI: 1265889984
Provider Name (Legal Business Name): TIFFANY MAGERS RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2016
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 2ND ST
LANGDON ND
58249-2407
US

IV. Provider business mailing address

909 2ND ST
LANGDON ND
58249-2407
US

V. Phone/Fax

Practice location:
  • Phone: 701-256-6100
  • Fax:
Mailing address:
  • Phone: 701-256-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1037
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number964673
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: