Provider Demographics
NPI:1891963336
Name:SCHRADER, DIANE KAY (RD)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:KAY
Last Name:SCHRADER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2770 E 800TH ST
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:IL
Mailing Address - Zip Code:62351-2617
Mailing Address - Country:US
Mailing Address - Phone:217-242-1746
Mailing Address - Fax:
Practice Address - Street 1:2770 E 800TH ST
Practice Address - Street 2:
Practice Address - City:MENDON
Practice Address - State:IL
Practice Address - Zip Code:62351-2617
Practice Address - Country:US
Practice Address - Phone:217-242-1746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered