Provider Demographics
NPI:1578697298
Name:ALLEN, ROSELEEN M (MS, RD, CDE)
Entity Type:Individual
Prefix:MS
First Name:ROSELEEN
Middle Name:M
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MS, RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5670 DAVIS FORD RD
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112-3054
Mailing Address - Country:US
Mailing Address - Phone:703-690-3465
Mailing Address - Fax:703-583-1445
Practice Address - Street 1:5670 DAVIS FORD RD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20112-3054
Practice Address - Country:US
Practice Address - Phone:703-690-3465
Practice Address - Fax:703-583-1445
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCD170133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
6811671-002OtherCIGNA
737610OtherAETNA
215281OtherMAMSI, UNITED HEALTHCARE
C170OtherCAREFIRST