Healthcare Provider Details

I. General information

NPI: 1235033986
Provider Name (Legal Business Name): MIA ROSE LANEMANN RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL
SAINT LOUIS MO
63110-1002
US

IV. Provider business mailing address

2141 MATILDA CT
WASHINGTON MO
63090-5293
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-6051
  • Fax:
Mailing address:
  • Phone: 636-432-8867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number2026045622
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: