Provider Demographics
NPI:1457530818
Name:MISNER, DIANE B (RD)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:B
Last Name:MISNER
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 1:25 BIRDSEYE GLN
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-2304
Mailing Address - Country:US
Mailing Address - Phone:973-857-1590
Mailing Address - Fax:973-989-3603
Practice Address - Street 1:400 W BLACKWELL ST
Practice Address - Street 2:REGIONAL DIABETES CENTER
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-2525
Practice Address - Country:US
Practice Address - Phone:973-989-3637
Practice Address - Fax:973-398-9304
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ564534133V00000X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic