MEDICARE: DIANE GRABOWSKI-NEPA RD

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	687215	CA

General Provider Information

NPI Number	:	1942651500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE GRABOWSKI-NEPA RD

Provider Business Mailing Address
First Line	:	3038 SUMMIT CIR
Second Line	:
City	:	SANTA ROSA VALLEY
State	:	CA
Zip	:	93012-9315
Country	:	US
Telephone Number	:	805-491-2592
Fax Number	:	805-491-2592

Provider Business Practice Location Address
First Line	:	3038 SUMMIT CIR
Second Line	:
City	:	SANTA ROSA VALLEY
State	:	CA
Zip	:	93012-9315
Country	:	US
Telephone Number	:	805-491-2592
Fax Number	:	805-491-2592

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

Provider Enumeration Date	:	06/24/2016
Last Update Date	:	06/24/2016

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