Maryse Beaudouin Derosena, BS MHA LDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Practice address

2405 Essington Rd
Suite # 80
Joliet, IL 60435-1200

Phone

(815) 236-6441

Fax

(630) 293-2937

NPI assigned

Aug 22, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1285740324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2405 ESSINGTON RD",
            "address_2": "SUITE # 80",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604351200",
            "telephone_number": "815-236-6441",
            "fax_number": "630-293-2937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2405 ESSINGTON RD",
            "address_2": "SUITE # 80",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604351200",
            "telephone_number": "815-236-6441",
            "fax_number": "630-293-2937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEROSENA",
        "first_name": "MARYSE",
        "middle_name": "BEAUDOUIN",
        "name_prefix": "Mrs.",
        "credential": "BS MHA LDN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Registered Dietitian in Joliet, IL
• Providers in Joliet, IL by specialty
• Registered Dietitian in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.