Provider Demographics
NPI:1629228218
Name:JANELLE DIETZE LLC
Entity Type:Organization
Organization Name:JANELLE DIETZE LLC
Other - Org Name:APPLE A DAY NUTRITION COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DIETZE
Authorized Official - Suffix:
Authorized Official - Credentials:RD CSG LD
Authorized Official - Phone:254-449-0166
Mailing Address - Street 1:5610 GRAPHITE DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-5358
Mailing Address - Country:US
Mailing Address - Phone:254-449-0166
Mailing Address - Fax:
Practice Address - Street 1:416 N GRAY ST
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-5247
Practice Address - Country:US
Practice Address - Phone:254-449-0166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT07397133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty