Provider Demographics
NPI:1043548837
Name:KAEMMER, DIANE (RD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:KAEMMER
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 1:135 TOWN ST
Mailing Address - Street 2:
Mailing Address - City:EAST HADDAM
Mailing Address - State:CT
Mailing Address - Zip Code:06423-1458
Mailing Address - Country:US
Mailing Address - Phone:860-873-3561
Mailing Address - Fax:860-873-3561
Practice Address - Street 1:135 TOWN ST
Practice Address - Street 2:
Practice Address - City:EAST HADDAM
Practice Address - State:CT
Practice Address - Zip Code:06423-1458
Practice Address - Country:US
Practice Address - Phone:860-873-3561
Practice Address - Fax:860-873-3561
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000689133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered