Provider Demographics
NPI:1609332295
Name:DEW, DIANE MARIE (RDN, LD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:DEW
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6849 NETHERLAND DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45044-9158
Mailing Address - Country:US
Mailing Address - Phone:513-218-9649
Mailing Address - Fax:
Practice Address - Street 1:6849 NETHERLAND DR
Practice Address - Street 2:
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45044-9158
Practice Address - Country:US
Practice Address - Phone:513-218-9649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3311133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered