Provider Demographics
NPI:1871923953
Name:ROSEMAN, MARY GRANACHER (PHD, RD, LD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:GRANACHER
Last Name:ROSEMAN
Suffix:
Gender:F
Credentials:PHD, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CREEK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-8673
Mailing Address - Country:US
Mailing Address - Phone:859-333-8807
Mailing Address - Fax:
Practice Address - Street 1:120 CREEK RIDGE DR
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-8673
Practice Address - Country:US
Practice Address - Phone:859-333-8807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD1601133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered