Provider Demographics
NPI:1447409669
Name:BOGER-WAKEMAN, SUSAN (PHD, RD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:BOGER-WAKEMAN
Suffix:
Gender:F
Credentials:PHD, RD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:BOGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, RD
Mailing Address - Street 1:150 PRICES CRK
Mailing Address - Street 2:
Mailing Address - City:SALUDA
Mailing Address - State:NC
Mailing Address - Zip Code:28773-6758
Mailing Address - Country:US
Mailing Address - Phone:828-329-6976
Mailing Address - Fax:
Practice Address - Street 1:150 PRICES CRK
Practice Address - Street 2:
Practice Address - City:SALUDA
Practice Address - State:NC
Practice Address - Zip Code:28773-6758
Practice Address - Country:US
Practice Address - Phone:828-329-6976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002487133V00000X
SC134133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered