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General NPI Number Information
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NPI Number | 1114258357
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Entity Type | Individual
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Provider Name | DIANE ELAINE BLACK MS,RD,CDE
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Gender | Female
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Dates
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Enumeration Date | 01/28/2010
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Last Update Date | 01/28/2010
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Provider Practice Location Address
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Address Line | 2157 APPERSON DR
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City | SALEM
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State | VA
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Zip | 24153-7235
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Country | US
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Telephone | 540-777-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 10102 EDGECOMBE PL NE
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City | BAINBRIDGE ISLAND
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State | WA
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Zip | 98110-4334
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Country | US
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Telephone | 412-400-3204
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 572543
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License Number State | PA
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