Healthcare Provider Details

I. General information

NPI: 1528114915
Provider Name (Legal Business Name): SUSAN C ROSZEL REGISTERED DIETICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 OHIO PIKE SUITE 300
CINCINNATI OH
45255-0000
US

IV. Provider business mailing address

P.O. BOX 635156
CINCINNATI OH
45263-5156
US

V. Phone/Fax

Practice location:
  • Phone: 513-528-5600
  • Fax: 513-528-9716
Mailing address:
  • Phone: 513-528-5600
  • Fax: 513-528-9716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD.3999
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: