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General NPI Number Information
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NPI Number | 1427161199
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Entity Type | Individual
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Provider Name | ROSLYN RUTH BOLZER R.D., L.N.
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Gender | Female
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 04/19/2010
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Provider Practice Location Address
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Address Line | 1000 HEALTH CENTER ROAD
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City | KYLE
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State | SD
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Zip | 57752-0540
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Country | US
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Telephone | 605-455-8823
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Fax | 605-455-1584
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Provider Business Mailing Address
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Address Line | PO BOX 540 1000 HEALTH CENTER ROAD
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City | KYLE
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State | SD
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Zip | 57752-0540
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Country | US
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Telephone | 605-455-8239
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Fax | 605-455-1584
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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 | 0150
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License Number State | SD
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