Provider Demographics
NPI:1497537856
Name:ROSBERG, ANAM KHAN
Entity Type:Individual
Prefix:
First Name:ANAM
Middle Name:KHAN
Last Name:ROSBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 POMEROY LN
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-7446
Mailing Address - Country:US
Mailing Address - Phone:847-630-1569
Mailing Address - Fax:
Practice Address - Street 1:128 POMEROY LN
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-7446
Practice Address - Country:US
Practice Address - Phone:847-630-1569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist