Provider Demographics
NPI:1518769215
Name:WALDNER, TIFFANY ROCHELLE (MS, RDN, LD)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ROCHELLE
Last Name:WALDNER
Suffix:
Gender:
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18101 W 119TH ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-9532
Mailing Address - Country:US
Mailing Address - Phone:515-695-3223
Mailing Address - Fax:833-719-1241
Practice Address - Street 1:18101 W 119TH ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-9532
Practice Address - Country:US
Practice Address - Phone:515-695-3223
Practice Address - Fax:833-719-1241
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3269133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered