Provider Demographics
NPI:1972756823
Name:HYLAND, ROSALEA PETILLO (MS RD LD)
Entity Type:Individual
Prefix:
First Name:ROSALEA
Middle Name:PETILLO
Last Name:HYLAND
Suffix:
Gender:F
Credentials:MS RD LD
Other - Prefix:
Other - First Name:LEA
Other - Middle Name:P
Other - Last Name:HYLAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS RD LD
Mailing Address - Street 1:14 BRENTWOOD CV
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-7301
Mailing Address - Country:US
Mailing Address - Phone:501-941-7645
Mailing Address - Fax:501-843-8504
Practice Address - Street 1:1919 WEST 12TH STREET
Practice Address - Street 2:800 MARSHALL STREET SLOT 900
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202
Practice Address - Country:US
Practice Address - Phone:501-364-6577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR585133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist