Provider Demographics
NPI:1649355322
Name:LEWIS, SUSAN ELLEN (RD)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ELLEN
Last Name:LEWIS
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 1:114 WHITWELL ST
Mailing Address - Street 2:QUINCY MEDICAL CENTER, FOOD AND NUTRITION DEPT
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-1870
Mailing Address - Country:US
Mailing Address - Phone:617-376-5386
Mailing Address - Fax:671-376-7605
Practice Address - Street 1:114 WHITWELL ST
Practice Address - Street 2:QUINCY MEDICAL CENTER, FOOD AND NUTRITION DEPT
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-1870
Practice Address - Country:US
Practice Address - Phone:617-376-5386
Practice Address - Fax:671-376-7605
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1281133NN1002X, 133V00000X, 133VN1005X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Not Answered133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Not Answered133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic