Rosannah M. Mack, RD,CD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

915393 Issued in IN

Practice address

600 East Blvd
Nutrition Services Department
Elkhart, IN 46514-2483

Phone

(574) 523-3236

Fax

(574) 296-6504

NPI assigned

Dec 5, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1239235200000",
    "number": "1508924259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4667",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466344667",
            "telephone_number": "574-523-3148",
            "fax_number": "574-523-3492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 EAST BLVD",
            "address_2": "NUTRITION SERVICES DEPARTMENT",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465142483",
            "telephone_number": "574-523-3236",
            "fax_number": "574-296-6504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "ROSANNAH",
        "middle_name": "M.",
        "name_prefix": "Mrs.",
        "credential": "RD,CD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-05",
        "last_updated": "2009-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IN",
            "license": "915393",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "915393",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE CERTIFICATION NUMBE",
            "identifier": "37001470A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Luxottica Retail North America Inc
• Alyssa Lynch
• Hannah Lyon
• Daniel Maas, MD
• Jermaine Mack
• Heather A. Macklem, M.D.
• Ali A Mahamat, MASTER OF PSYCHOLOGY
• Rebecca Mahlie, CRNA
• Deborah Sue Maiden, FNP-C
• Luke Maier

• Registered Dietitian in Elkhart, IN
• Providers in Elkhart, IN by specialty
• Registered Dietitian in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2009; 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.