Provider Demographics
NPI:1104080746
Name:WHITE, SUSAN M (RD, LDN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:WHITE
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:TOWANDA
Mailing Address - State:PA
Mailing Address - Zip Code:18848-9702
Mailing Address - Country:US
Mailing Address - Phone:570-268-2343
Mailing Address - Fax:570-268-2285
Practice Address - Street 1:91 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848-9702
Practice Address - Country:US
Practice Address - Phone:570-268-2343
Practice Address - Fax:570-268-2285
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000431133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered