Provider Demographics
NPI:1548705924
Name:TANSKY, JODI (CNTP)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:TANSKY
Suffix:
Gender:F
Credentials:CNTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4445 EIELSON FARM RD
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-7016
Mailing Address - Country:US
Mailing Address - Phone:907-699-1409
Mailing Address - Fax:
Practice Address - Street 1:4445 EIELSON FARM RD
Practice Address - Street 2:
Practice Address - City:NORTH POLE
Practice Address - State:AK
Practice Address - Zip Code:99705-7016
Practice Address - Country:US
Practice Address - Phone:907-699-1409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education