Diane M Grogan

Individual provider Active NPI Registered Dietitian · Ronan, MT

NPI 1013261031 · NPPES record last updated Oct 29, 2012

Key facts

NPI
1013261031
Entity type
Individual (NPI type 1)
Primary specialty
Registered Dietitian 133V00000X
License
258 (MT)
Practice address
107 6TH Ave SW
Ronan, MT 59864-2634
Phone
(406) 676-4441
Fax
(406) 676-0835
NPI assigned
Oct 29, 2012
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
258MTMDRegistered Dietitian

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 258 MT Yes

Addresses

Primary practice location

107 6TH Ave SW
Ronan, MT 59864-2634

Mailing address

107 6TH Ave SW
Ronan, MT 59864-2634
Phone (406) 676-4441

Other providers in Ronan, MT

All providers in Ronan, MT · Registered Dietitian in Montana

Sources for this page

Verify at the official NPI Registry.