Provider Demographics
NPI:1306391925
Name:LAFFERTY, DIANE MARIE (MS RDN LDN)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:LAFFERTY
Suffix:
Gender:F
Credentials:MS RDN LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 ESTATE DR
Mailing Address - Street 2:
Mailing Address - City:EADS
Mailing Address - State:TN
Mailing Address - Zip Code:38028-3133
Mailing Address - Country:US
Mailing Address - Phone:901-482-1279
Mailing Address - Fax:731-658-4216
Practice Address - Street 1:165 ESTATE DR
Practice Address - Street 2:
Practice Address - City:EADS
Practice Address - State:TN
Practice Address - Zip Code:38028-3133
Practice Address - Country:US
Practice Address - Phone:901-482-1279
Practice Address - Fax:731-658-4216
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1591133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered