Provider Demographics
NPI:1730219494
Name:ERTEL, ROSEMARY MOULD (RD)
Entity type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:MOULD
Last Name:ERTEL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ROSEMARY
Other - Middle Name:SARAH
Other - Last Name:MOULD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:86 RAINBOW CIR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-2320
Mailing Address - Country:US
Mailing Address - Phone:423-267-5935
Mailing Address - Fax:423-495-7978
Practice Address - Street 1:2525 DESALES AVE
Practice Address - Street 2:MEMORIAL HOSPIAL- DIABETES CENTER
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1161
Practice Address - Country:US
Practice Address - Phone:423-495-7971
Practice Address - Fax:423-495-7978
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDN0000000880133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered