| Doctor Name: | ROSELLE MARTIN |
| NPI Number: | 1225483415 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | B.S, L.N |
| License Number: | |
| Business Practice Address: | 1058 College Dr New Town, ND - 587639112 |
| Business Phone Number: | 7016277913 |
| Business Fax Number: | 7016273913 |
| Mailing Address: | 1058 College Dr, NEW TOWN |
| State: | ND |
| Postal Code: | 587639112 |
| Phone Number: | 7016277913 |
| Fax Number: | 7016273913 |
| NPI Enumeration Date: | 04/26/2016 |
| NPI Last Update Date: | 04/26/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133NN1002X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ND |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Nutritionist |
| Taxonomy Specialization: | Nutrition, Education |
| Taxonomy Definition: | |