Provider Demographics
NPI:1417227927
Name:LEVON, SUSANNAH EVANS (RD)
Entity Type:Individual
Prefix:MRS
First Name:SUSANNAH
Middle Name:EVANS
Last Name:LEVON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:SUSANNAH
Other - Middle Name:ELIZABETH
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 WILSON AVE SW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-5684
Mailing Address - Country:US
Mailing Address - Phone:319-366-2700
Mailing Address - Fax:
Practice Address - Street 1:20 WILSON AVE SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-5684
Practice Address - Country:US
Practice Address - Phone:319-366-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-01
Last Update Date:2012-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01229133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered