Provider Demographics
NPI:1063728863
Name:BOWERS, DIANA (PHD, RN, RD)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:BOWERS
Suffix:
Gender:F
Credentials:PHD, RN, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 E WILSON BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-2369
Mailing Address - Country:US
Mailing Address - Phone:614-566-0850
Mailing Address - Fax:
Practice Address - Street 1:404 E WILSON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2369
Practice Address - Country:US
Practice Address - Phone:614-566-0850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1862133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic