Provider Demographics
NPI:1114219136
Name:HAN, SUSIE S (RDN, LD)
Entity type:Individual
Prefix:MS
First Name:SUSIE
Middle Name:S
Last Name:HAN
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 ARION PKWY STE 434
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-2837
Mailing Address - Country:US
Mailing Address - Phone:210-499-0063
Mailing Address - Fax:
Practice Address - Street 1:814 ARION PKWY STE 434
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-2837
Practice Address - Country:US
Practice Address - Phone:210-499-0063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT86911133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered