Provider Demographics
NPI:1275998668
Name:COLLINS, DIANE PAIGE (NUTRITIONIST)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:PAIGE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:NUTRITIONIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 WHITTAKER CT
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-2559
Mailing Address - Country:US
Mailing Address - Phone:301-735-6747
Mailing Address - Fax:
Practice Address - Street 1:2006 WHITTAKER CT
Practice Address - Street 2:
Practice Address - City:DISTRICT HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20747-2559
Practice Address - Country:US
Practice Address - Phone:301-735-6747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD81116133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education