Provider Demographics
NPI:1063578839
Name:KEIZER, SUSAN KAY (MSED, RD, LMNT, CDE)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:KAY
Last Name:KEIZER
Suffix:
Gender:F
Credentials:MSED, RD, LMNT, CDE
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:KAY
Other - Last Name:KLINGINSMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED, RD, LMNT
Mailing Address - Street 1:4211 LINDEN DR
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-2507
Mailing Address - Country:US
Mailing Address - Phone:308-240-0056
Mailing Address - Fax:
Practice Address - Street 1:3219 CENTRAL AVE
Practice Address - Street 2:PLATTE VALLEY MEDICAL GROUP
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-2949
Practice Address - Country:US
Practice Address - Phone:308-865-2263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE430133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered