Individual
DIANE C MARCENGILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
200 FLEETWOOD DR, EASLEY, SC 29640-2022
(864) 442-7200
(864) 442-7579
Mailing address
PO BOX 651466, CHARLOTTE, NC 28265-1466
(864) 442-7200
(864) 442-7579
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
RD716286
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
582296052504
HOSPITAL TAX ID #
SC
01
—
RD716286
LICENSE #
SC
Enumeration date
09/16/2006
Last updated
07/09/2007
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