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NPI 1306332978

NPI 1306332978 : ROSEMARY GATLIFF RD : LITTLE ROCK, AR

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General NPI Number Information
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    NPI Number           |    1306332978
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    Entity Type          |    Individual 
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    Provider Name        |    ROSEMARY GATLIFF RD
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    07/07/2018
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    Last Update Date     |    07/07/2018
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Provider Practice Location Address
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    Address Line         |    4300 W 7TH ST 
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    City                 |    LITTLE ROCK
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    State                |    AR
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    Zip                  |    72205-5446
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    Country              |    US
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    Telephone            |    501-257-1000
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    201 S ROGERS RD APT C43 
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    City                 |    HOT SPRINGS
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    State                |    AR
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    Zip                  |    71913-6380
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    Country              |    US
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    Telephone            |    
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    Fax                  |    
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Authorized Official
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    Title or Position    |    
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    Name                 |        
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    Credential           |    
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    Telephone            |    
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    133V00000X
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    Taxonomy Name        |    Registered Dietitian
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    License Number       |    86148271
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    License Number State |    AR
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