Provider Demographics
NPI:1144970054
Name:WOLFF, TANYA (RD, LDN)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:WOLFF
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1056 ROYAL DUBLIN LN
Mailing Address - Street 2:
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-1279
Mailing Address - Country:US
Mailing Address - Phone:651-341-5854
Mailing Address - Fax:
Practice Address - Street 1:1056 ROYAL DUBLIN LN
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1279
Practice Address - Country:US
Practice Address - Phone:651-341-5854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered