Provider Demographics
NPI:1992041115
Name:PEARSON, SUSAN DEAN
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DEAN
Last Name:PEARSON
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 1:4629 CALVIN DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-2814
Mailing Address - Country:US
Mailing Address - Phone:361-442-0432
Mailing Address - Fax:
Practice Address - Street 1:4629 CALVIN DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-2814
Practice Address - Country:US
Practice Address - Phone:361-442-0432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-15
Last Update Date:2012-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133N00000XDietary & Nutritional Service ProvidersNutritionist