Healthcare Provider Details

I. General information

NPI: 1336602614
Provider Name (Legal Business Name): RYANN RYCHELLE ROSIER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 04/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 N COLLEGE ST
ALBANY MO
64402-1433
US

IV. Provider business mailing address

705 N COLLEGE ST
ALBANY MO
64402-1433
US

V. Phone/Fax

Practice location:
  • Phone: 660-726-3941
  • Fax: 660-726-3647
Mailing address:
  • Phone: 660-726-3941
  • Fax: 660-726-3647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2013025399
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: