Provider Demographics
NPI:1780821710
Name:DIETRICH, SUZANNE MARIE (RD)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:MARIE
Last Name:DIETRICH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E 2ND ST
Mailing Address - Street 2:302
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1262
Mailing Address - Country:US
Mailing Address - Phone:775-784-7500
Mailing Address - Fax:775-784-7505
Practice Address - Street 1:1500 E 2ND ST
Practice Address - Street 2:302
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1262
Practice Address - Country:US
Practice Address - Phone:775-784-7500
Practice Address - Fax:775-784-7505
Is Sole Proprietor?:No
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered