Provider Demographics
NPI:1508211749
Name:LAY, SUSAN (ND)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:LAY
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 NW 177TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-8917
Mailing Address - Country:US
Mailing Address - Phone:405-226-5808
Mailing Address - Fax:
Practice Address - Street 1:2601 NW 177TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-8917
Practice Address - Country:US
Practice Address - Phone:405-226-5808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-25
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1508211749133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education