Provider Demographics
NPI:1568550846
Name:HARRISON, SUSAN CORRIS
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:CORRIS
Last Name:HARRISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 N SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-2831
Mailing Address - Country:US
Mailing Address - Phone:970-641-2055
Mailing Address - Fax:
Practice Address - Street 1:902 N SPRUCE ST
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-2831
Practice Address - Country:US
Practice Address - Phone:970-641-2055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered