Provider Demographics
NPI:1639209406
Name:ANDERSON, ROSEANNA (RD LDN)
Entity Type:Individual
Prefix:
First Name:ROSEANNA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 PLYMOUTH ROAD
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-2803
Mailing Address - Country:US
Mailing Address - Phone:215-718-6599
Mailing Address - Fax:215-517-8180
Practice Address - Street 1:25 WASHINGTON LANE
Practice Address - Street 2:SUITE 6A2
Practice Address - City:WYNCOTE
Practice Address - State:PA
Practice Address - Zip Code:19095
Practice Address - Country:US
Practice Address - Phone:215-517-7777
Practice Address - Fax:215-517-8180
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000282133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133N00000XDietary & Nutritional Service ProvidersNutritionist
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered