Provider Demographics
NPI:1013558931
Name:ROULETTE, BERNISHA PLAYER (RD, CDN, CLC)
Entity Type:Individual
Prefix:
First Name:BERNISHA
Middle Name:PLAYER
Last Name:ROULETTE
Suffix:
Gender:F
Credentials:RD, CDN, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 E 107TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1829
Mailing Address - Country:US
Mailing Address - Phone:318-936-5001
Mailing Address - Fax:
Practice Address - Street 1:1515 E 107TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1829
Practice Address - Country:US
Practice Address - Phone:318-936-5001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.08465133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered