Active NPI
Jeanette Christine Roskom, RDN
- Registered Dietitian
- Wrightstown, WI
National Provider Identifier
1336009885
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 627629
- Practice address
- 202 Plum Rd Ste a
Wrightstown, WI 54180-7302 - Phone
- (920) 664-3119
- NPI assigned
- Nov 17, 2025
- Last updated
- Nov 17, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 627629 | WI | Primary |
Addresses
Primary practice location
202 Plum Rd Ste a
Wrightstown, WI 54180-7302
Mailing address
6317 State Highway 57
De Pere, WI 54115-9621
Phone (920) 664-3119
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 627629 | WI | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1763337600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1763337600000",
"number": "1336009885",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6317 STATE HIGHWAY 57",
"city": "DE PERE",
"state": "WI",
"postal_code": "541159621",
"telephone_number": "920-664-3119",
"fax_number": "920-664-3119"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "202 PLUM RD STE A",
"city": "WRIGHTSTOWN",
"state": "WI",
"postal_code": "541807302",
"telephone_number": "920-664-3119"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSKOM",
"first_name": "JEANETTE",
"middle_name": "CHRISTINE",
"credential": "RDN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-11-17",
"last_updated": "2025-11-17",
"certification_date": "2025-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "WI",
"license": "627629",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wrightstown, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.