Provider Demographics
NPI:1083871230
Name:ROSENAU, MARTHA (RD)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:
Last Name:ROSENAU
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 S TEJON ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-4026
Mailing Address - Country:US
Mailing Address - Phone:719-548-9859
Mailing Address - Fax:719-471-8452
Practice Address - Street 1:606 S TEJON ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-4026
Practice Address - Country:US
Practice Address - Phone:719-548-9859
Practice Address - Fax:719-471-8452
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered