Individual
DIANE HODGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
500 N US HIGHWAY 89, PRESCOTT, AZ 86313-5001
(928) 445-4860
Mailing address
500 N US HIGHWAY 89, PRESCOTT, AZ 86313-5001
(928) 445-4860
Taxonomy
Speciality
Code
Description
License number
State
133VN1006X
Metabolic Nutrition Registered Dietitian
Primary
00800
GA
Other
Enumeration date
08/06/2021
Last updated
08/06/2021
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