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General NPI Number Information
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NPI Number | 1144316027
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Entity Type | Individual
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Provider Name | DIANA M GRANEY RD
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Gender | Female
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 419 S WASHINGTON STREET SUITE 200
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City | CASPER
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State | WY
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Zip | 82601
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Country | US
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Telephone | 307-237-8400
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Fax | 307-265-8313
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Provider Business Mailing Address
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Address Line | PO BOX 51106
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City | CASPER
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State | WY
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Zip | 82605
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Country | US
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Telephone | 307-237-8400
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Fax | 307-265-8313
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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 | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | 712579
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License Number State |
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