Healthcare Provider Details

I. General information

NPI: 1700907409
Provider Name (Legal Business Name): DIANA M. MILLER MPH, RD, LDN, CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PARKER LN SUITE 1
PINEHURST NC
28374-7903
US

IV. Provider business mailing address

306 CROSS ST
SANFORD NC
27330-3818
US

V. Phone/Fax

Practice location:
  • Phone: 910-295-3133
  • Fax: 910-295-2723
Mailing address:
  • Phone: 919-776-0324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberL002904
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: