Provider Demographics
NPI:1356467542
Name:FETZER, SUSAN G (MS, RDN, LDN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:G
Last Name:FETZER
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 ARENDELL ST
Mailing Address - Street 2:CARTERET GENERAL HOSPITAL
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-2901
Mailing Address - Country:US
Mailing Address - Phone:252-808-6115
Mailing Address - Fax:808-808-6920
Practice Address - Street 1:3500 ARENDELL ST
Practice Address - Street 2:CARTERET GENERAL HOSPITAL
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-2901
Practice Address - Country:US
Practice Address - Phone:252-808-6115
Practice Address - Fax:808-808-6920
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL000680133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered