Provider Demographics
NPI:1851663116
Name:MORSE, SUSAN (RD)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:MORSE
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 1:3930 SAVANNAH LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-7994
Mailing Address - Country:US
Mailing Address - Phone:479-530-5717
Mailing Address - Fax:479-756-8810
Practice Address - Street 1:3930 SAVANNAH LN
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-7994
Practice Address - Country:US
Practice Address - Phone:479-530-5717
Practice Address - Fax:479-756-8810
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR782133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric