Provider Demographics
NPI:1821530395
Name:RODEN, CYNTHIA ANNE (RD, LD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANNE
Last Name:RODEN
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 1:400 E 3RD ST
Mailing Address - Street 2:ESSENTIA HEALTH DULUTH CLINIC MCL2CRED
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-1951
Mailing Address - Country:US
Mailing Address - Phone:218-786-1183
Mailing Address - Fax:
Practice Address - Street 1:109 COURT AVE S
Practice Address - Street 2:ESSENTIA HEALTH SANDSTONE
Practice Address - City:SANDSTONE
Practice Address - State:MN
Practice Address - Zip Code:55072-5120
Practice Address - Country:US
Practice Address - Phone:320-245-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1292133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered