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General NPI Number Information
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NPI Number | 1588745715
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Entity Type | Individual
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Provider Name | JEANNE MARIE DIEBERT RD
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Gender | Female
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 222 E. MAIN UNIT 1F
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City | ENNIS
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State | MT
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Zip | 59729
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Country | US
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Telephone | 406-599-0039
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1316
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City | ENNIS
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State | MT
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Zip | 59729-1316
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Country | US
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Telephone | 406-599-0039
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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 | 513
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License Number State | MT
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