Provider Demographics
NPI:1013296466
Name:WHITE, SUSAN JANE (RD, CDE)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:JANE
Last Name:WHITE
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 ASPEN CT
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27856
Mailing Address - Country:US
Mailing Address - Phone:919-757-9921
Mailing Address - Fax:
Practice Address - Street 1:1041 NOELL LN
Practice Address - Street 2:ST 101
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2058
Practice Address - Country:US
Practice Address - Phone:252-446-6964
Practice Address - Fax:252-442-4531
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002322133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered