Healthcare Provider Details

I. General information

NPI: 1750075537
Provider Name (Legal Business Name): DANA KATHERINE ROSCOE MS, RDN LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E 3RD ST APT 301
DAYTON OH
45402-5105
US

IV. Provider business mailing address

500 E 3RD ST APT 301
DAYTON OH
45402-5105
US

V. Phone/Fax

Practice location:
  • Phone: 630-842-7058
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD.10100
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: