Basic Information
| Provider Information | |||||||||
| NPI: | 1407045107 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DANCHI | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | LYNNETTE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | L.D.N, R.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CARROLL | ||||||||
| OtherFirstName: | DIANE | ||||||||
| OtherMiddleName: | LYNNETTE | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 211 FRIDAY CENTER DR | ||||||||
| Address2: | SUITE 2091, ROOM 2094 HEDRICK BUILDING | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275179499 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9849741191 | ||||||||
| FaxNumber: | 9849741311 | ||||||||
| Practice Location | |||||||||
| Address1: | 1515 SW CARY PARKWAY | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275116225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193870080 | ||||||||
| FaxNumber: | 9193873908 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2007 | ||||||||
| LastUpdateDate: | 09/14/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133N00000X | L000710 | NC | N | Dietary & Nutritional Service Providers | Nutritionist | 133NN1002X | 000710 | NC | N | Dietary & Nutritional Service Providers | Nutritionist | Nutrition, Education | 133V00000X | L000710 | NC | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | Q50644A | 01 | NC | MEDICARE PTAN | OTHER | Q50644E853 | 01 | NC | MEDICARE PTAN | OTHER |