Provider Demographics
NPI:1982228193
Name:BOWSER, SUZANNE MAE (PHD RD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MAE
Last Name:BOWSER
Suffix:
Gender:F
Credentials:PHD RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:973 LANE 38
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82411-9700
Mailing Address - Country:US
Mailing Address - Phone:208-821-2658
Mailing Address - Fax:
Practice Address - Street 1:973 LANE 38
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WY
Practice Address - Zip Code:82411-9700
Practice Address - Country:US
Practice Address - Phone:208-821-2658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered