Provider Demographics
NPI:1912982653
Name:SEYKORA, SUSAN T (RD, LD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:T
Last Name:SEYKORA
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 1:501 N STATE ST
Mailing Address - Street 2:WASECA MEDICAL CENTER - MAYO HEALTH SYSTEM
Mailing Address - City:WASECA
Mailing Address - State:MN
Mailing Address - Zip Code:56093
Mailing Address - Country:US
Mailing Address - Phone:507-835-1210
Mailing Address - Fax:507-837-4280
Practice Address - Street 1:501 N STATE ST
Practice Address - Street 2:WASECA MEDICAL CENTER - MAYO HEALTH SYSTEM
Practice Address - City:WASECA
Practice Address - State:MN
Practice Address - Zip Code:56093
Practice Address - Country:US
Practice Address - Phone:507-835-1210
Practice Address - Fax:507-837-4280
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN727534133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN63-00264OtherMEDICA