Provider Demographics
NPI:1245498187
Name:DIBIASE, LEE ANN (MS,RD,LD)
Entity type:Individual
Prefix:MS
First Name:LEE
Middle Name:ANN
Last Name:DIBIASE
Suffix:
Gender:F
Credentials:MS,RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 1ST ST
Mailing Address - Street 2:SUITE 204-115
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-5389
Mailing Address - Country:US
Mailing Address - Phone:330-612-3910
Mailing Address - Fax:
Practice Address - Street 1:157 N OVIATT ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-2907
Practice Address - Country:US
Practice Address - Phone:330-612-3910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5674133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered