Healthcare Provider Details

I. General information

NPI: 1205948858
Provider Name (Legal Business Name): CHARLOTTE M ROMMEREIM RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30470 481ST AVE
ALCESTER SD
57001-6306
US

IV. Provider business mailing address

30470 481ST AVE
ALCESTER SD
57001-6306
US

V. Phone/Fax

Practice location:
  • Phone: 605-934-2951
  • Fax:
Mailing address:
  • Phone: 605-934-2951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number0124
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number00459
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: