Provider Demographics
NPI:1033935473
Name:KEPPINGER, LILLIAN ROZANSKI (RD)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:ROZANSKI
Last Name:KEPPINGER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:LILLIAN
Other - Middle Name:DARE
Other - Last Name:ROZANSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3022 MARYE ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-4930
Mailing Address - Country:US
Mailing Address - Phone:318-451-6947
Mailing Address - Fax:
Practice Address - Street 1:1585 3RD ST
Practice Address - Street 2:
Practice Address - City:FORT JOHNSON
Practice Address - State:LA
Practice Address - Zip Code:71459-5102
Practice Address - Country:US
Practice Address - Phone:318-451-6947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-02
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2916133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered