Provider Demographics
NPI:1447384037
Name:ROSELLE, REBECCA SUE (CNS)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:SUE
Last Name:ROSELLE
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:R.
Other - Middle Name:SUE
Other - Last Name:ROSELLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNS
Mailing Address - Street 1:8500 EXECUTIVE PARK AVENUE
Mailing Address - Street 2:#300
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4647
Mailing Address - Country:US
Mailing Address - Phone:703-698-7117
Mailing Address - Fax:703-698-5729
Practice Address - Street 1:8500 EXECUTIVE PARK AVENUE
Practice Address - Street 2:#300
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4647
Practice Address - Country:US
Practice Address - Phone:703-698-7117
Practice Address - Fax:703-698-5729
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA10022133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist