Individual
TIFFANY LYN BOSIACKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
11211 NICOLES WAY, CHARDON, OH 44024-9383
(440) 479-1552
Mailing address
11211 NICOLES WAY, CHARDON, OH 44024-9383
(440) 479-1552
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
5565
OH
Other
Enumeration date
02/23/2007
Last updated
08/10/2015
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