Provider Demographics
NPI:1598094237
Name:WEAVER, ROSEMARY (RD)
Entity Type:Individual
Prefix:MRS
First Name:ROSEMARY
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ROSEMARY
Other - Middle Name:
Other - Last Name:MUELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1410 N. ARLINGTON HEIGHTS ROAD, SUITE 200
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-4827
Mailing Address - Country:US
Mailing Address - Phone:847-618-1640
Mailing Address - Fax:847-618-1649
Practice Address - Street 1:1410 N. ARLINGTON HEIGHTS ROAD, SUITE 200
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-4827
Practice Address - Country:US
Practice Address - Phone:847-618-1640
Practice Address - Fax:847-618-1649
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-08
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.001068133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL164001068OtherSTATE LICENSE