Provider Demographics
NPI:1689884421
Name:STAUDER, ROSE ANNE ELIZABETH (RD, LD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:ROSE ANNE
Middle Name:ELIZABETH
Last Name:STAUDER
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:MISS
Other - First Name:ROSE ANNE
Other - Middle Name:E
Other - Last Name:ANTHONY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD, CDE
Mailing Address - Street 1:37976 CAROLINE DR
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-1110
Mailing Address - Country:US
Mailing Address - Phone:440-934-8831
Mailing Address - Fax:
Practice Address - Street 1:2351 E 22ND ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-3111
Practice Address - Country:US
Practice Address - Phone:216-861-6200
Practice Address - Fax:216-241-5631
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD. 4295133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHANMT71441Medicare ID - Type UnspecifiedGROUP UH3600371