Provider Demographics
NPI:1265889984
Name:MAGERS, TIFFANY (RD, LD)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:MAGERS
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LANGDON
Mailing Address - State:ND
Mailing Address - Zip Code:58249-2407
Mailing Address - Country:US
Mailing Address - Phone:701-256-6100
Mailing Address - Fax:
Practice Address - Street 1:909 2ND ST
Practice Address - Street 2:
Practice Address - City:LANGDON
Practice Address - State:ND
Practice Address - Zip Code:58249-2407
Practice Address - Country:US
Practice Address - Phone:701-256-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1037133V00000X
964673133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered