Provider Demographics
NPI:1417406638
Name:ROSE, PAULA JEANNE (RD)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:JEANNE
Last Name:ROSE
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 1:26897 FREDERICK AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA STATION
Mailing Address - State:OH
Mailing Address - Zip Code:44028-9804
Mailing Address - Country:US
Mailing Address - Phone:216-905-2682
Mailing Address - Fax:
Practice Address - Street 1:26897 FREDERICK AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA STATION
Practice Address - State:OH
Practice Address - Zip Code:44028-9804
Practice Address - Country:US
Practice Address - Phone:216-905-2682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-29
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered