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NPI Code Detail

MEDICARE: SEL ROSE

MEDICARE: SEL ROSE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133N00000XNutritionist
2133NN1002XNutrition Education Nutritionist
3133V00000XRegistered Dietitian
4133VN1006XMetabolic Nutrition Registered Dietitian
5133VN1101XGerontological Nutrition Registered Dietitian

General Provider Information

NPI Number : 1437018413
Entity Type Code : Organization
Provider Name (Legal Business Name) : SEL ROSE
Provider Business Mailing Address
First Line : PO BOX 27738
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19118-0738
Country : US
Telephone Number : 215-779-1328
Fax Number :
Provider Business Practice Location Address
First Line : 3400 SPRUCE ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19104-4238
Country : US
Telephone Number : 215-779-1328
Fax Number :
Authorized Official
Title or Position : DIETITIAN/NUTRITIONIST
Name : LISA NORRIS
Credential : RD LDN
Telephone Number : 215-779-1328
Provider Enumeration Date : 01/16/2026
Last Update Date : 01/16/2026

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Directions to “SEL ROSE ” Practice Location

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