Provider Demographics
NPI:1649577677
Name:STEVENS, ROSLYNE (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:ROSLYNE
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 MAPLE AVE
Mailing Address - Street 2:GENESIS HEALTHPLEX
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-1716
Mailing Address - Country:US
Mailing Address - Phone:740-454-4568
Mailing Address - Fax:740-586-6770
Practice Address - Street 1:2800 MAPLE AVE
Practice Address - Street 2:GENESIS HEALTHPLEX
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1716
Practice Address - Country:US
Practice Address - Phone:740-454-4568
Practice Address - Fax:740-586-6770
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD633133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered