Provider Demographics
NPI:1699007641
Name:MILLER, SUZANNE (RD, LDN)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 FOX HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-3747
Mailing Address - Country:US
Mailing Address - Phone:336-297-1393
Mailing Address - Fax:
Practice Address - Street 1:204 MUIRS CHAPEL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-6173
Practice Address - Country:US
Practice Address - Phone:336-542-2892
Practice Address - Fax:336-834-0442
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL001210133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered