Provider Demographics
NPI:1902097504
Name:THERIEAU, DIANNE (RD, RN, LDN, CDOE)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:
Last Name:THERIEAU
Suffix:
Gender:F
Credentials:RD, RN, LDN, CDOE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 STEWART ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038-1254
Mailing Address - Country:US
Mailing Address - Phone:508-528-3444
Mailing Address - Fax:
Practice Address - Street 1:84 STEWART ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038-1254
Practice Address - Country:US
Practice Address - Phone:508-528-3444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILDN00537133V00000X
MA2142133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered