Provider Demographics
NPI:1740724020
Name:HOLMES ROBERTS, SUSAN M (RDN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:HOLMES ROBERTS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 SW COVES DR
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-9143
Mailing Address - Country:US
Mailing Address - Phone:515-689-7115
Mailing Address - Fax:
Practice Address - Street 1:3210 SW COVES DR
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-9143
Practice Address - Country:US
Practice Address - Phone:515-689-7115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-06
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA86059632133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered