Individual
TAMMY WISCOVITCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1515 VILLAGE DR, COTTAGE GROVE, OR 97424-9700
(541) 767-5311
Mailing address
1732 W 27TH PL, EUGENE, OR 97405-1730
(909) 578-2434
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
10215552
OR
133V00000X
Registered Dietitian
Primary
753576
OR
Other
Enumeration date
12/05/2024
Last updated
01/20/2025
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