Provider Demographics
NPI:1720147531
Name:FLEMING, SUZANNE MICHELE (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:MICHELE
Last Name:FLEMING
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:MISS
Other - First Name:SUZANNE
Other - Middle Name:MICHELE
Other - Last Name:LONGENECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 S ASH ST
Mailing Address - Street 2:
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460-5405
Mailing Address - Country:US
Mailing Address - Phone:620-241-2250
Mailing Address - Fax:
Practice Address - Street 1:1000 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-2326
Practice Address - Country:US
Practice Address - Phone:620-241-2251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1332133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS130657Medicare UPIN