Active NPI
Diane Marie Selleck, RD
- Metabolic Nutrition Registered Dietitian
- Parker, AZ
National Provider Identifier
1750503900
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Metabolic Nutrition Registered Dietitian
- License
- 932530
- Practice address
- 12033 Agency Rd
Parker, AZ 85344-7718 - Phone
- (928) 669-3283
- NPI assigned
- May 3, 2007
- Last updated
- Oct 23, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Metabolic Nutrition Registered Dietitian | 133VN1006X | 932530 | NU | Primary |
Addresses
Primary practice location
12033 Agency Rd
Parker, AZ 85344-7718
Mailing address
122 Sunflower Dr
Lake Havasu City, AZ 86403-6658
Phone (928) 855-5289
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 37001488A | Other | IN | DIETITIAN CERTIFICATION |
| 932530 | Other | CDR REGISTRATION ID NUMBE |
Other names 1
- Diane Selleck Haywood
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)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| DHHS IHS Phoenix Area | Current | Accepting new patients |
Locations
12033 Agency Rd
Parker, AZ 85344
Phone (760) 572-4137
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193097600000",
"number": "1750503900",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "122 SUNFLOWER DR",
"city": "LAKE HAVASU CITY",
"state": "AZ",
"postal_code": "864036658",
"telephone_number": "928-855-5289"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12033 AGENCY RD",
"city": "PARKER",
"state": "AZ",
"postal_code": "853447718",
"telephone_number": "928-669-3283"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SELLECK",
"first_name": "DIANE",
"middle_name": "MARIE",
"credential": "RD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-03",
"last_updated": "2007-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "133VN1006X",
"taxonomy_group": "",
"desc": "Dietitian, Registered, Nutrition, Metabolic",
"state": "NU",
"license": "932530",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DIETITIAN CERTIFICATION",
"identifier": "37001488A",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CDR REGISTRATION ID NUMBE",
"identifier": "932530",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"first_name": "DIANE",
"last_name": "HAYWOOD",
"middle_name": "SELLECK",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Parker, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.