Provider Demographics
NPI:1033121975
Name:HAASE, ROSALYN H (RD CD)
Entity Type:Individual
Prefix:
First Name:ROSALYN
Middle Name:H
Last Name:HAASE
Suffix:
Gender:F
Credentials:RD CD
Other - Prefix:
Other - First Name:ROSALYN
Other - Middle Name:L
Other - Last Name:HOVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3860 MONROE RD
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-8399
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3860 MONROE RD
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-8399
Practice Address - Country:US
Practice Address - Phone:920-496-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI62 029133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI710000652Medicare ID - Type UnspecifiedMEDICARE RR
WI002961030Medicare ID - Type Unspecified
WI000271800Medicare ID - Type UnspecifiedDIABETES EDUCATION