Provider Demographics
NPI:1366080590
Name:RAMSEY, TIFFANY (RD, CD)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:RAMSEY
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:SCHAEFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CD
Mailing Address - Street 1:N6775 LONG LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BRILLION
Mailing Address - State:WI
Mailing Address - Zip Code:54110-9456
Mailing Address - Country:US
Mailing Address - Phone:920-470-7778
Mailing Address - Fax:
Practice Address - Street 1:10 TRI PARK WAY
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-1658
Practice Address - Country:US
Practice Address - Phone:920-831-0070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1028790133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered