Active NPI
Diane K Walker, RN CDE
- Registered Dietetic Technician
- Crandon, WI
National Provider Identifier
1710282678
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietetic Technician
- License
- 90435 30
- Practice address
- 3144 Vanzile Road
Crandon, WI 54520-0275 - Phone
- (715) 478-5180
- Fax
- (715) 478-5904
- NPI assigned
- Jan 24, 2011
- Last updated
- Jan 24, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietetic Technician | 136A00000X | 90435 30 | WI | Primary |
Addresses
Primary practice location
3144 Vanzile Road
Crandon, WI 54520-0275
Mailing address
1 N Hill Road
Wausau, WI 54403
Phone (715) 478-5180
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 90435 30 | Other | WI | WI LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 90435 30 | WI | MD | Registered Dietetic Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1295827200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1295827200000",
"number": "1710282678",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 N HILL ROAD",
"city": "WAUSAU",
"state": "WI",
"postal_code": "54403",
"telephone_number": "715-478-5180",
"fax_number": "715-478-5904"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3144 VANZILE ROAD",
"city": "CRANDON",
"state": "WI",
"postal_code": "545200275",
"telephone_number": "715-478-5180",
"fax_number": "715-478-5904"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALKER",
"first_name": "DIANE",
"middle_name": "K",
"credential": "RN CDE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-01-24",
"last_updated": "2011-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "136A00000X",
"taxonomy_group": "",
"desc": "Dietetic Technician, Registered",
"state": "WI",
"license": "90435 30",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WI LICENSE",
"identifier": "90435 30",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Crandon, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.