Individual
MRS. DIANE R LEVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LD, CDE
Contact information
Practice address
4002 KRESGE WAY, SUITE 124, LOUISVILLE, KY 40207-4661
(502) 895-4263
(502) 899-5488
Mailing address
PO BOX 950248, LOUISVILLE, KY 40295-0248
(502) 489-5730
(502) 489-5753
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
0635
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000255836
ANTHEM BC/BS PROVIDER NO.
KY
Enumeration date
09/06/2005
Last updated
02/01/2016
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