Basic Information
| Provider Information | |||||||||
| NPI: | 1104034651 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORRIS | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | R.D., L.D., CDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 305 E 1ST ST | ||||||||
| Address2: | |||||||||
| City: | UHRICHSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446831803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7409229694 | ||||||||
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| Practice Location | |||||||||
| Address1: | 659 BOULEVARD ST | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446222026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303433311 | ||||||||
| FaxNumber: | 3306050734 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 4264 | OH | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.