Provider Demographics
NPI:1376972273
Name:BENJAMIN, ROSEMARY P (RD,CD,CDE)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:P
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:RD,CD,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 W STATE ST
Mailing Address - Street 2:BUILDING B, SUITE C
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-3438
Mailing Address - Country:US
Mailing Address - Phone:765-494-0111
Mailing Address - Fax:765-496-6656
Practice Address - Street 1:1400 W STATE ST
Practice Address - Street 2:BUILDING B, SUITE C
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-3438
Practice Address - Country:US
Practice Address - Phone:765-494-0111
Practice Address - Fax:765-496-6656
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INR534087133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic