1063578839 NPI number — MS. SUSAN KAY KEIZER MSED, RD, LMNT, CDE

Table of content: MS. SUSAN KAY KEIZER MSED, RD, LMNT, CDE (NPI 1063578839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063578839 NPI number — MS. SUSAN KAY KEIZER MSED, RD, LMNT, CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEIZER
Provider First Name:
SUSAN
Provider Middle Name:
KAY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSED, RD, LMNT, CDE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KLINGINSMITH
Provider Other First Name:
SUSAN
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSED, RD, LMNT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1063578839
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4211 LINDEN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEARNEY
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68847-2507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-240-0056
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3219 CENTRAL AVE
Provider Second Line Business Practice Location Address:
PLATTE VALLEY MEDICAL GROUP
Provider Business Practice Location Address City Name:
KEARNEY
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68847-2949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-865-2263
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  430 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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