Provider Demographics
NPI:1093535585
Name:MARSHALL, SUSAN (RD, CSPCC, CNSC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:RD, CSPCC, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5628 S QUATAR CT
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-6005
Mailing Address - Country:US
Mailing Address - Phone:530-400-2557
Mailing Address - Fax:
Practice Address - Street 1:13123 E 16TH AVE # 270
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7106
Practice Address - Country:US
Practice Address - Phone:720-777-4902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
966480133VN1401X, 133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1401XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric Critical Care
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric