Healthcare Provider Details

I. General information

NPI: 1962505222
Provider Name (Legal Business Name): DIANA MARINA BOTERO-JOERGER REGISTERED DIETITIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 C EMERY RD
DINGMANS FERRY PA
18328-9613
US

IV. Provider business mailing address

RR2 1016 C EMERY RD
DINGMANS FERRY PA
18328-9613
US

V. Phone/Fax

Practice location:
  • Phone: 570-828-6444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN002213
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN000322
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: