Provider Demographics
NPI:1497192249
Name:FORSBERG, SUZANNE LYNN (RD, LD, CDE)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:LYNN
Last Name:FORSBERG
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14500 S 4240 RD
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-1127
Mailing Address - Country:US
Mailing Address - Phone:918-352-5201
Mailing Address - Fax:
Practice Address - Street 1:14500 S 4240 RD
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-1127
Practice Address - Country:US
Practice Address - Phone:918-352-5201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
818967133V00000X
OKLD990133VN1006X
09720118133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic