Provider Demographics
NPI:1437231073
Name:VAN TREECK, DIANNE (MS,RD,CDE,LD/N)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:
Last Name:VAN TREECK
Suffix:
Gender:F
Credentials:MS,RD,CDE,LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 GATEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8304
Mailing Address - Country:US
Mailing Address - Phone:561-737-1070
Mailing Address - Fax:561-536-0411
Practice Address - Street 1:1375 GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8304
Practice Address - Country:US
Practice Address - Phone:561-737-1070
Practice Address - Fax:561-536-0411
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 849133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLNPIOtherAETNA
FL1169978OtherCOVENTRY HEALTHCARE
FLPR47554650001OtherCIGNA
FLNPIOtherUNITED HEALTHCARE
FLGGXLBOtherFL BLUE HMO
E6705Medicare ID - Type Unspecified