Provider Demographics
NPI:1386303865
Name:HANCOCK, TAMMI (RD)
Entity type:Individual
Prefix:
First Name:TAMMI
Middle Name:
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:TAMMI
Other - Middle Name:
Other - Last Name:STIB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:5304 STONY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-3107
Mailing Address - Country:US
Mailing Address - Phone:989-607-9694
Mailing Address - Fax:
Practice Address - Street 1:5304 STONY CREEK DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-3107
Practice Address - Country:US
Practice Address - Phone:989-607-9694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered