Provider Demographics
NPI:1205948858
Name:ROMMEREIM, CHARLOTTE M (RD)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:M
Last Name:ROMMEREIM
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30470 481ST AVE
Mailing Address - Street 2:
Mailing Address - City:ALCESTER
Mailing Address - State:SD
Mailing Address - Zip Code:57001-6306
Mailing Address - Country:US
Mailing Address - Phone:605-934-2951
Mailing Address - Fax:
Practice Address - Street 1:30470 481ST AVE
Practice Address - Street 2:
Practice Address - City:ALCESTER
Practice Address - State:SD
Practice Address - Zip Code:57001-6306
Practice Address - Country:US
Practice Address - Phone:605-934-2951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0124133V00000X
IA00459133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
658318OtherCDR REGISTRATION
658318OtherCDR REGISTRATION
SDS41042Medicare PIN