Provider Demographics
NPI:1881134500
Name:KREAGER, SUSAN (RDN, LD, CDE)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:KREAGER
Suffix:
Gender:F
Credentials:RDN, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 382
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WY
Mailing Address - Zip Code:82515-0382
Mailing Address - Country:US
Mailing Address - Phone:307-438-2405
Mailing Address - Fax:
Practice Address - Street 1:643 BLUE SKY HWY 132
Practice Address - Street 2:
Practice Address - City:ETHETE
Practice Address - State:WY
Practice Address - Zip Code:82520
Practice Address - Country:US
Practice Address - Phone:307-332-8035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-28
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
WY087133V00000X, 133VN1004X, 133VN1006X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174H00000XOther Service ProvidersHealth Educator
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education