Provider Demographics
NPI:1003027418
Name:FRANKLIN, DIANE MARIE (RD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:FRANKLIN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 NE MARIGOLD ST
Mailing Address - Street 2:
Mailing Address - City:MADRAS
Mailing Address - State:OR
Mailing Address - Zip Code:97741-1003
Mailing Address - Country:US
Mailing Address - Phone:541-475-4329
Mailing Address - Fax:
Practice Address - Street 1:1270 KOT NUM RD
Practice Address - Street 2:
Practice Address - City:WARM SPRINGS
Practice Address - State:OR
Practice Address - Zip Code:97761
Practice Address - Country:US
Practice Address - Phone:541-553-1196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
912675133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR273855Medicaid
8HD466Medicare ID - Type Unspecified
ORQ39941Medicare UPIN