Healthcare Provider Details

I. General information

NPI: 1437231073
Provider Name (Legal Business Name): DIANNE VAN TREECK MS,RD,CDE,LD/N
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 04/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 GATEWAY BLVD
BOYNTON BEACH FL
33426-8304
US

IV. Provider business mailing address

1375 GATEWAY BLVD
BOYNTON BEACH FL
33426-8304
US

V. Phone/Fax

Practice location:
  • Phone: 561-737-1070
  • Fax: 561-536-0411
Mailing address:
  • Phone: 561-737-1070
  • Fax: 561-536-0411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND 849
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: