Healthcare Provider Details

I. General information

NPI: 1689884421
Provider Name (Legal Business Name): ROSE ANNE ELIZABETH STAUDER RD, LD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROSE ANNE E ANTHONY RD, LD, CDE

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 04/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2351 E 22ND ST
CLEVELAND OH
44115-3111
US

IV. Provider business mailing address

37976 CAROLINE DR
AVON OH
44011-1110
US

V. Phone/Fax

Practice location:
  • Phone: 216-861-6200
  • Fax: 216-241-5631
Mailing address:
  • Phone: 440-934-8831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberLD. 4295
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: