Provider Demographics
NPI:1063422269
Name:ROSENTHAL, ANN LOUISE (RD, CDE)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:LOUISE
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:LOUISE
Other - Last Name:FORTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CDE
Mailing Address - Street 1:590 SYKORA LN
Mailing Address - Street 2:PO BOX 466
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022-8227
Mailing Address - Country:US
Mailing Address - Phone:715-425-7346
Mailing Address - Fax:
Practice Address - Street 1:1700 UNIVERSITY AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-3727
Practice Address - Country:US
Practice Address - Phone:651-232-5757
Practice Address - Fax:651-232-4972
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2286133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered