Provider Demographics
NPI:1811761380
Name:ROSSETTI, ILIANNA (CNS , ABAAHP)
Entity type:Individual
Prefix:
First Name:ILIANNA
Middle Name:
Last Name:ROSSETTI
Suffix:
Gender:F
Credentials:CNS , ABAAHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 ISLINGTON ST APT 50
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7214
Mailing Address - Country:US
Mailing Address - Phone:917-687-7024
Mailing Address - Fax:
Practice Address - Street 1:1 MERRILL INDUSTRIAL DR STE 26
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03842-1981
Practice Address - Country:US
Practice Address - Phone:917-521-5993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001042133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist