| Doctor Name: | MS. TAMARA JEAN NISLY |
| NPI Number: | 1386687648 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | REGISTERED DIETICIAN |
| License Number: | 956889 |
| Business Practice Address: | 10 S 6th St Cottonwood, AZ - 863264236 |
| Business Phone Number: | 9286398130 |
| Business Fax Number: | 9286398179 |
| Mailing Address: | 1090 Commerce Dr, PRESCOTT |
| State: | AZ |
| Postal Code: | 863053700 |
| Phone Number: | 9287713122 |
| Fax Number: | 9287713369 |
| NPI Enumeration Date: | 06/14/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | 956889 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |