Provider Demographics
NPI:1114568979
Name:SUTER, CRYSTAL (RD)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:SUTER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:234 CENTER CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-3013
Mailing Address - Country:US
Mailing Address - Phone:412-952-2141
Mailing Address - Fax:
Practice Address - Street 1:234 CENTER CHURCH RD
Practice Address - Street 2:
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-3013
Practice Address - Country:US
Practice Address - Phone:412-952-2141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003057133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered