Provider Demographics
NPI:1710089529
Name:SPEAR, DIANE M (RD)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:M
Last Name:SPEAR
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 CRAVEN CT
Mailing Address - Street 2:
Mailing Address - City:MANNFORD
Mailing Address - State:OK
Mailing Address - Zip Code:74044-3006
Mailing Address - Country:US
Mailing Address - Phone:918-865-7867
Mailing Address - Fax:
Practice Address - Street 1:106 CRAVEN CT
Practice Address - Street 2:
Practice Address - City:MANNFORD
Practice Address - State:OK
Practice Address - Zip Code:74044-3006
Practice Address - Country:US
Practice Address - Phone:918-865-7867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK417133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered