Individual
COLLEEN ROUSH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
444 BRUCE ST, YREKA, CA 96097-3450
(530) 841-6212
Mailing address
444 BRUCE ST, YREKA, CA 96097-3450
(530) 841-6212
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
85007840
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255663050
—
CA
Enumeration date
02/03/2010
Last updated
07/01/2010
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