Healthcare Provider Details

I. General information

NPI: 1508134172
Provider Name (Legal Business Name): ROSEMARY M RICH RD LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2011
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1349 22ND RD NE
WAVERLY KS
66871-9115
US

IV. Provider business mailing address

1349 22ND RD NE
WAVERLY KS
66871-9115
US

V. Phone/Fax

Practice location:
  • Phone: 620-256-6716
  • Fax:
Mailing address:
  • Phone: 620-256-6716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number281
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: