Provider Demographics
NPI:1487795928
Name:ROSENOW, CYNTHIA KAE (RD, CD)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:KAE
Last Name:ROSENOW
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18001 N 79TH AVE STE A12
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8398
Mailing Address - Country:US
Mailing Address - Phone:623-399-6825
Mailing Address - Fax:623-505-3474
Practice Address - Street 1:871 CORONADO CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3977
Practice Address - Country:US
Practice Address - Phone:702-830-9685
Practice Address - Fax:702-623-2921
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001729133V00000X
NV39643-DI-0133V00000X
NV39643-DI-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV39643-DI-0OtherNV DIETICIAN LICENSE
WA8451833Medicaid
NV39643-DI-1OtherNV DIETITIAN LICENSE