Provider Demographics
NPI:1962505222
Name:BOTERO-JOERGER, DIANA MARINA (REGISTERED DIETITIAN)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:MARINA
Last Name:BOTERO-JOERGER
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR2 1016 C EMERY RD
Mailing Address - Street 2:
Mailing Address - City:DINGMANS FERRY
Mailing Address - State:PA
Mailing Address - Zip Code:18328-9613
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1016 C EMERY RD
Practice Address - Street 2:
Practice Address - City:DINGMANS FERRY
Practice Address - State:PA
Practice Address - Zip Code:18328-9613
Practice Address - Country:US
Practice Address - Phone:570-828-6444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN002213133V00000X
NYDN000322133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered