Provider Demographics
NPI:1700907409
Name:MILLER, DIANA M (MPH, RD, LDN, CLC)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:M
Last Name:MILLER
Suffix:
Gender:F
Credentials:MPH, RD, LDN, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 CROSS ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-3818
Mailing Address - Country:US
Mailing Address - Phone:919-776-0324
Mailing Address - Fax:
Practice Address - Street 1:10 PARKER LN
Practice Address - Street 2:SUITE 1
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-7903
Practice Address - Country:US
Practice Address - Phone:910-295-3133
Practice Address - Fax:910-295-2723
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002904133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3403400Medicaid