Provider Demographics
NPI:1194922799
Name:LAMBERT, DIANE C (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:C
Last Name:LAMBERT
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:MO
Mailing Address - Zip Code:64601-1554
Mailing Address - Country:US
Mailing Address - Phone:660-707-4367
Mailing Address - Fax:660-707-4323
Practice Address - Street 1:100 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:MO
Practice Address - Zip Code:64601-1554
Practice Address - Country:US
Practice Address - Phone:660-707-4367
Practice Address - Fax:660-707-4323
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001006915133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO358970002Medicaid
MO358970002Medicare ID - Type Unspecified