Healthcare Provider Details

I. General information

NPI: 1104607951
Provider Name (Legal Business Name): HANNAH ROSE ROFKAHR MS, RDN, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 LONGVIEW RD
OZARK AR
72949-8139
US

IV. Provider business mailing address

3115 LONGVIEW RD
OZARK AR
72949-8139
US

V. Phone/Fax

Practice location:
  • Phone: 479-209-1903
  • Fax:
Mailing address:
  • Phone: 479-209-9303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86299731
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: