Provider Demographics
NPI:1821561481
Name:ROSENTHAL, KATHARINE CAMPBELL (RDN, LD)
Entity Type:Individual
Prefix:MRS
First Name:KATHARINE
Middle Name:CAMPBELL
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:MISS
Other - First Name:KATHARINE
Other - Middle Name:CAMPBELL
Other - Last Name:SELBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1609 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-3426
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1609 CEDAR ST
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-3426
Practice Address - Country:US
Practice Address - Phone:563-262-4131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA094396133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered