MEDICARE: MARIANA DINEEN M.S., R.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1063831055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIANA DINEEN M.S., R.D.

Provider Business Mailing Address
First Line	:	1827 N LARRABEE ST APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-6578
Country	:	US
Telephone Number	:	917-420-9994
Fax Number	:

Provider Business Practice Location Address
First Line	:	1827 N LARRABEE ST APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-6578
Country	:	US
Telephone Number	:	917-420-9994
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2014
Last Update Date	:	09/26/2022

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