Provider Demographics
NPI:1285468330
Name:LAIRD, TONYA JANE (RDN)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:JANE
Last Name:LAIRD
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 4TH AVE E
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-5345
Mailing Address - Country:US
Mailing Address - Phone:425-503-7372
Mailing Address - Fax:
Practice Address - Street 1:430 WINDWARD WAY STE 100
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-2619
Practice Address - Country:US
Practice Address - Phone:406-751-5454
Practice Address - Fax:406-756-2716
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-30
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-NUTR-LIC-132433133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered