Individual
TAMMY BLANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
EXECUTIVE DIRECTOR
Contact information
Practice address
621 HARRIS ST, NACOGDOCHES, TX 75964-5205
(936) 569-6350
(936) 560-1797
Mailing address
621 HARRIS ST, NACOGDOCHES, TX 75964-5205
(936) 569-6350
(936) 560-1797
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
751579473
TX
Other
Enumeration date
08/21/2014
Last updated
08/21/2014
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