Individual
DIANE MARIE SELLECK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
12033 AGENCY RD, PARKER, AZ 85344-7718
(928) 669-3283
Mailing address
122 SUNFLOWER DR, LAKE HAVASU CITY, AZ 86403-6658
(928) 855-5289
Taxonomy
Speciality
Code
Description
License number
State
133VN1006X
Metabolic Nutrition Registered Dietitian
Primary
932530
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37001488A
DIETITIAN CERTIFICATION
IN
01
—
932530
CDR REGISTRATION ID NUMBE
—
Enumeration date
05/03/2007
Last updated
10/23/2007
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