Provider Demographics
NPI:1528212313
Name:ROLLINS, DIANE BENTLEY (PHD, RD, LD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:BENTLEY
Last Name:ROLLINS
Suffix:
Gender:F
Credentials:PHD, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 HEATHERBROOK CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-4052
Mailing Address - Country:US
Mailing Address - Phone:817-481-5971
Mailing Address - Fax:
Practice Address - Street 1:1614 HEATHERBROOK CT
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-4052
Practice Address - Country:US
Practice Address - Phone:817-481-5971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-06
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT03326133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered