Provider Demographics
NPI:1740308329
Name:CAMPBELL, SUSAN LOUISE (RD LD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:LOUISE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 ULMERTON RD
Mailing Address - Street 2:#51
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-4948
Mailing Address - Country:US
Mailing Address - Phone:321-663-8716
Mailing Address - Fax:
Practice Address - Street 1:6900 ULMERTON RD
Practice Address - Street 2:#51
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-4948
Practice Address - Country:US
Practice Address - Phone:321-663-8716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4984133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered