Provider Demographics
NPI:1407510340
Name:WALSH, ROSANNE (RD, LDN)
Entity Type:Individual
Prefix:
First Name:ROSANNE
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 MYSTIC ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-1915
Mailing Address - Country:US
Mailing Address - Phone:617-501-9213
Mailing Address - Fax:
Practice Address - Street 1:29 MYSTIC ST
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-1915
Practice Address - Country:US
Practice Address - Phone:617-702-2732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA86114529133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty