Provider Demographics
NPI:1275893026
Name:MARCH, SUSAN BURKE (RD, CDE, LD/N)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:BURKE
Last Name:MARCH
Suffix:
Gender:F
Credentials:RD, CDE, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 LAMBERT AVENUE
Mailing Address - Street 2:
Mailing Address - City:FLAGLER BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32136
Mailing Address - Country:US
Mailing Address - Phone:386-439-2980
Mailing Address - Fax:386-439-2980
Practice Address - Street 1:1090 LAMBERT AVE
Practice Address - Street 2:
Practice Address - City:FLAGLER BEACH
Practice Address - State:FL
Practice Address - Zip Code:32136
Practice Address - Country:US
Practice Address - Phone:386-439-2980
Practice Address - Fax:386-439-2980
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND3604133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist