Provider Demographics
NPI:1225247133
Name:MAGNER, ROSE MARIE (RD, LD)
Entity Type:Individual
Prefix:MS
First Name:ROSE
Middle Name:MARIE
Last Name:MAGNER
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 1ST ST SE
Mailing Address - Street 2:
Mailing Address - City:WAUKON
Mailing Address - State:IA
Mailing Address - Zip Code:52172-2022
Mailing Address - Country:US
Mailing Address - Phone:563-568-3411
Mailing Address - Fax:563-568-6139
Practice Address - Street 1:40 1ST ST SE
Practice Address - Street 2:
Practice Address - City:WAUKON
Practice Address - State:IA
Practice Address - Zip Code:52172-2022
Practice Address - Country:US
Practice Address - Phone:563-568-3411
Practice Address - Fax:563-568-6139
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00658133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI5542Medicare UPIN