Provider Demographics
NPI:1518717941
Name:WENDERSKI, ROSE (RD, MS)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:WENDERSKI
Suffix:
Gender:F
Credentials:RD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 KINA ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-3719
Mailing Address - Country:US
Mailing Address - Phone:808-234-4930
Mailing Address - Fax:
Practice Address - Street 1:1114 KINA ST
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-3719
Practice Address - Country:US
Practice Address - Phone:808-234-4930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI391-LD133V00000X
MN5222133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered