Provider Demographics
NPI:1407096761
Name:NEWBY, SUSAN ELAINE (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ELAINE
Last Name:NEWBY
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30519 NW 100TH AVE
Mailing Address - Street 2:
Mailing Address - City:PRATT
Mailing Address - State:KS
Mailing Address - Zip Code:67124-7816
Mailing Address - Country:US
Mailing Address - Phone:620-895-6494
Mailing Address - Fax:620-895-6494
Practice Address - Street 1:30519 NW 100TH AVE
Practice Address - Street 2:
Practice Address - City:PRATT
Practice Address - State:KS
Practice Address - Zip Code:67124-7816
Practice Address - Country:US
Practice Address - Phone:620-895-6494
Practice Address - Fax:620-895-6494
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS466133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered