MEDICARE: MS. CYNTHIA KAE ROSENOW RD, CD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	DI00001729	WA
2	133V00000X	Registered Dietitian	39643-DI-0	NV
3	133V00000X	Registered Dietitian	39643-DI-1	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	39643-DI-0	OTHER	NV	NV DIETICIAN LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	39643-DI-1	OTHER	NV	NV DIETITIAN LICENSE

General Provider Information

NPI Number	:	1487795928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CYNTHIA KAE ROSENOW RD, CD

Provider Business Mailing Address
First Line	:	18001 N 79TH AVE STE A12
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-8398
Country	:	US
Telephone Number	:	623-399-6825
Fax Number	:	623-505-3474

Provider Business Practice Location Address
First Line	:	871 CORONADO CENTER DR STE 200
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-3977
Country	:	US
Telephone Number	:	702-830-9685
Fax Number	:	702-623-2921

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	08/29/2023

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