Individual
MRS. STEFANIE BLAKE TUBIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, CDN, IBCLC
Contact information
Practice address
9070 MICHAEL DOUGLAS DR, CLARENCE CENTER, NY 14032-9276
(716) 741-0107
Mailing address
9070 MICHAEL DOUGLAS DR, CLARENCE CENTER, NY 14032-9276
(716) 741-0107
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
807729
NY
Other
Enumeration date
11/05/2012
Last updated
11/05/2012
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