Provider Demographics
NPI:1043874886
Name:TRIPP, SUSAN ANNE (MS, RD, LDN, CNSC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANNE
Last Name:TRIPP
Suffix:
Gender:F
Credentials:MS, RD, LDN, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 BELMONT STREET
Mailing Address - Street 2:5TH FLOOR NICU
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-334-6913
Mailing Address - Fax:
Practice Address - Street 1:119 BELMONT STREET
Practice Address - Street 2:5TH FLOOR NICU
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605
Practice Address - Country:US
Practice Address - Phone:508-334-6913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2889133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric