Provider Demographics
NPI:1942433768
Name:WEATHERS, DIANA LYNN (RD, LD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNN
Last Name:WEATHERS
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:LYNN
Other - Last Name:DILUCIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4685 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3397
Mailing Address - Country:US
Mailing Address - Phone:513-853-4722
Mailing Address - Fax:
Practice Address - Street 1:6200 PFEIFFER RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45242-5862
Practice Address - Country:US
Practice Address - Phone:513-862-4957
Practice Address - Fax:513-745-9010
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6354133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered