Provider Demographics
NPI:1023101136
Name:DIVEN, LYNN E (RD LD CDE)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:E
Last Name:DIVEN
Suffix:
Gender:F
Credentials:RD LD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 E PARK AVE
Mailing Address - Street 2:STE 312
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-6706
Mailing Address - Country:US
Mailing Address - Phone:814-689-3156
Mailing Address - Fax:814-689-1954
Practice Address - Street 1:1850 E PARK AVE
Practice Address - Street 2:STE 312
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-6706
Practice Address - Country:US
Practice Address - Phone:814-689-3156
Practice Address - Fax:814-689-1954
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003719133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered