Provider Demographics
NPI:1093960296
Name:COE, SUSAN M (RD, LMNT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:COE
Suffix:
Gender:F
Credentials:RD, LMNT
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:HEGEMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:1000 S 178TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118-3542
Mailing Address - Country:US
Mailing Address - Phone:402-334-4444
Mailing Address - Fax:402-334-4954
Practice Address - Street 1:1000 S 178TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-3542
Practice Address - Country:US
Practice Address - Phone:402-334-4444
Practice Address - Fax:402-334-4954
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE662133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered