Provider Demographics
NPI:1417579962
Name:DIENER, MIEKO (MPH, RD)
Entity Type:Individual
Prefix:
First Name:MIEKO
Middle Name:
Last Name:DIENER
Suffix:
Gender:F
Credentials:MPH, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 PINE VALLEY BLVD APT 8
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-6935
Mailing Address - Country:US
Mailing Address - Phone:510-219-7026
Mailing Address - Fax:
Practice Address - Street 1:2940 ELLSWORTH RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-7406
Practice Address - Country:US
Practice Address - Phone:734-572-5777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-07
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered