Provider Demographics
NPI:1154040756
Name:HOOVER, TAMARA LYNN (RD)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:LYNN
Last Name:HOOVER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 E 86TH ST APT 7F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-6473
Mailing Address - Country:US
Mailing Address - Phone:917-847-3066
Mailing Address - Fax:
Practice Address - Street 1:446 E 86TH ST APT 7F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-6473
Practice Address - Country:US
Practice Address - Phone:917-847-3066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86145369133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered