Healthcare Provider Details

I. General information

NPI: 1750926036
Provider Name (Legal Business Name): DIANE PIERZCHALA RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2019
Last Update Date: 11/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 LOON HILL RD
DRACUT MA
01826-4365
US

IV. Provider business mailing address

4 COLFAX ST
PEABODY MA
01960-5812
US

V. Phone/Fax

Practice location:
  • Phone: 978-323-0360
  • Fax:
Mailing address:
  • Phone: 978-979-6631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number4559
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: