Provider Demographics
NPI:1407109101
Name:HAYOSH, DIANE MARIE (RD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:HAYOSH
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 1:512 S BURNETT RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-2720
Mailing Address - Country:US
Mailing Address - Phone:937-328-3385
Mailing Address - Fax:
Practice Address - Street 1:512 S BURNETT RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-2720
Practice Address - Country:US
Practice Address - Phone:937-328-3385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered