Diane A. Clark, CD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

2104-29 Issued in WI

Practice address

Beloit Clinic
1905 E. Huebbe Parkway
Beloit, WI 53511-1842

Phone

(608) 364-2293

Fax

(608) 364-5452

NPI assigned

Feb 18, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1613606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613606400000",
    "number": "1568055812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "BELOIT CLINIC",
            "address_2": "1905 E. HUEBBE PARKWAY",
            "city": "BELOIT",
            "state": "WI",
            "postal_code": "535111842",
            "telephone_number": "608-364-2293",
            "fax_number": "608-364-5452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BELOIT CLINIC",
            "address_2": "1905 E. HUEBBE PARKWAY",
            "city": "BELOIT",
            "state": "WI",
            "postal_code": "535111842",
            "telephone_number": "608-364-2293",
            "fax_number": "608-364-5452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DIANE",
        "middle_name": "A.",
        "credential": "CD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-18",
        "last_updated": "2021-02-18",
        "certification_date": "2021-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "WI",
            "license": "2104-29",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Indrajit Choudhuri, M.D.
• Steven Stephen Choung, MD
• Ruth Christiansen, N.P.
• Kendall Christidis
• City of Beloit
• Rachel Lynn Clark, PTA
• Karlye Clausen, ATC
• Erin Clayton
• Clear Perspective Clinical Services LLC
• Alexis Coates

• Registered Dietitian in Beloit, WI
• Providers in Beloit, WI by specialty
• Registered Dietitian in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.