Individual
MS. LISA ANN ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, LDN
Contact information
Practice address
221 NE GLEN OAK AVE, PEORIA, IL 61636-0002
(309) 672-4954
(309) 672-4953
Mailing address
708 N ASHLAND AVE, WEST PEORIA, IL 61604-4903
(309) 637-6593
(309) 672-4953
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
IL
Other
Enumeration date
04/12/2007
Last updated
07/08/2007
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