Basic Information
| Provider Information | |||||||||
| NPI: | 1679896914 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROZELL | ||||||||
| FirstName: | CELIA | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | SCOTT AND WHITE HEALTHCARE TEMPLE DIALYSIS | ||||||||
| Address2: | 2401 SOUTH 31ST STREET | ||||||||
| City: | TEMPLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 765080001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547240827 | ||||||||
| FaxNumber: | 2547244685 | ||||||||
| Practice Location | |||||||||
| Address1: | SCOTT AND WHITE HEALTHCARE TEMPLE DIALYSIS | ||||||||
| Address2: | 2401 SOUTH 31ST STREET | ||||||||
| City: | TEMPLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 765080001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547240827 | ||||||||
| FaxNumber: | 2547244685 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2010 | ||||||||
| LastUpdateDate: | 04/06/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 719773 | TX | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | DT03363 | 01 | TX | HOSPITAL UNIT | OTHER |