Individual
MS. TAMARA JEAN NISLY
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
REGISTERED DIETICIAN
Contact information
Practice address
10 S 6TH ST, COTTONWOOD, AZ 86326-4236
(928) 639-8130
(928) 639-8179
Mailing address
1090 COMMERCE DR, PRESCOTT, AZ 86305-3700
(928) 771-3122
(928) 771-3369
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
956889
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
095604
—
AZ
Enumeration date
06/14/2006
Last updated
07/09/2007
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