Healthcare Provider Details

I. General information

NPI: 1396139416
Provider Name (Legal Business Name): ELIZABETH KATHLEEN MISHLER ROSENSTEIN R.D.N.,L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 11/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 PARK AVE HENNEPIN COUNTY MEDICAL CENTER
MINNEAPOLIS MN
55415-1623
US

IV. Provider business mailing address

701 PARK AVE HENNEPIN COUNTY MEDICAL CENTER
MINNEAPOLIS MN
55415-1623
US

V. Phone/Fax

Practice location:
  • Phone: 612-873-3723
  • Fax: 612-904-4651
Mailing address:
  • Phone: 612-873-3723
  • Fax: 612-904-4651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3484
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: