Provider Demographics
NPI:1265196554
Name:BOWDEN, DIANE (RDN, LDN, CLC)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:BOWDEN
Suffix:
Gender:F
Credentials:RDN, LDN, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3452 WELWYN WAY
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-8203
Mailing Address - Country:US
Mailing Address - Phone:850-591-3063
Mailing Address - Fax:
Practice Address - Street 1:3452 WELWYN WAY
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-8203
Practice Address - Country:US
Practice Address - Phone:850-591-3063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-24
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND501133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered