Healthcare Provider Details

I. General information

NPI: 1770113144
Provider Name (Legal Business Name): DIANE L HUTH RDN, CSG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2020
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 BLUEGRASS DR
BUTLER PA
16001-3411
US

IV. Provider business mailing address

221 BLUEGRASS DR
BUTLER PA
16001-3411
US

V. Phone/Fax

Practice location:
  • Phone: 724-991-7838
  • Fax:
Mailing address:
  • Phone: 724-991-7838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1101X
TaxonomyGerontological Nutrition Registered Dietitian
License NumberDN003126
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: