Provider Demographics
NPI:1508165192
Name:BOSSELMANN, DANA LYN (RD)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:LYN
Last Name:BOSSELMANN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:LYN
Other - Last Name:BENYSHEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:7659 E PINNACLE PEAK RD STE 105
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-6298
Mailing Address - Country:US
Mailing Address - Phone:928-606-4379
Mailing Address - Fax:
Practice Address - Street 1:7659 E PINNACLE PEAK RD STE 105
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-6298
Practice Address - Country:US
Practice Address - Phone:480-222-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ854845133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered