Provider Demographics
NPI:1538774203
Name:VERDIN, TAMMI MICHELE (LDN, RD)
Entity type:Individual
Prefix:MRS
First Name:TAMMI
Middle Name:MICHELE
Last Name:VERDIN
Suffix:
Gender:F
Credentials:LDN, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 201
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:LA
Mailing Address - Zip Code:71048
Mailing Address - Country:US
Mailing Address - Phone:318-245-0235
Mailing Address - Fax:318-353-6275
Practice Address - Street 1:164 PATTEN TOWN ROAD
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:LA
Practice Address - Zip Code:71048
Practice Address - Country:US
Practice Address - Phone:318-245-0235
Practice Address - Fax:318-353-6275
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA805839133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered