Provider Demographics
NPI:1144204660
Name:YURCZYK, ROSEMARY LYNN (RD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:ROSEMARY
Middle Name:LYNN
Last Name:YURCZYK
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 W 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4105
Mailing Address - Country:US
Mailing Address - Phone:405-377-1988
Mailing Address - Fax:405-624-1988
Practice Address - Street 1:2220 W 7TH AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4105
Practice Address - Country:US
Practice Address - Phone:405-377-1988
Practice Address - Fax:405-624-1988
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
R608042133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered