Provider Demographics
NPI:1144316027
Name:GRANEY, DIANA M (RD)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:M
Last Name:GRANEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51106
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82605
Mailing Address - Country:US
Mailing Address - Phone:307-237-8400
Mailing Address - Fax:307-265-8313
Practice Address - Street 1:419 S WASHINGTON STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601
Practice Address - Country:US
Practice Address - Phone:307-237-8400
Practice Address - Fax:307-265-8313
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
712579133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist