Provider Demographics
NPI:1689293797
Name:MANNING, DIANA BRYN (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:BRYN
Last Name:MANNING
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:BRYN
Other - Last Name:CHAMBERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9329 BOLTWOOD LN APT 205
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-2067
Mailing Address - Country:US
Mailing Address - Phone:901-361-2854
Mailing Address - Fax:
Practice Address - Street 1:7705 POPLAR AVE., MEDICAL OFFICE B
Practice Address - Street 2:SUITE 150
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138
Practice Address - Country:US
Practice Address - Phone:901-516-6357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3695133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered