Healthcare Provider Details

I. General information

NPI: 1396172474
Provider Name (Legal Business Name): LINDA ROZZELLE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 11/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

PO BOX 418283
BOSTON MA
02241-8283
US

V. Phone/Fax

Practice location:
  • Phone: 703-558-1456
  • Fax:
Mailing address:
  • Phone: 703-558-1456
  • Fax: 703-558-1445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI100000256
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: