Provider Demographics
NPI:1558433227
Name:ROESLER, TRICIA ANN (LRD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:ANN
Last Name:ROESLER
Suffix:
Gender:F
Credentials:LRD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15302 52 1/2 ST SE
Mailing Address - Street 2:
Mailing Address - City:LEONARD
Mailing Address - State:ND
Mailing Address - Zip Code:58052-9201
Mailing Address - Country:US
Mailing Address - Phone:701-645-0100
Mailing Address - Fax:
Practice Address - Street 1:403 ELM STREET
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:ND
Practice Address - Zip Code:58054
Practice Address - Country:US
Practice Address - Phone:701-683-5823
Practice Address - Fax:701-683-0034
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND691133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered