Provider Demographics
NPI:1912339375
Name:CARROLL, DIANE RAINEY (MS, RDN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:RAINEY
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10133 LAFOY DR
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-4659
Mailing Address - Country:US
Mailing Address - Phone:704-948-0789
Mailing Address - Fax:
Practice Address - Street 1:10133 LAFOY DR
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-4659
Practice Address - Country:US
Practice Address - Phone:704-948-0789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1083219133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered