Provider Demographics
NPI:1215986286
Name:BLOMELEY, SUSAN BEALL (RD, LDN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:BEALL
Last Name:BLOMELEY
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 1:538 FOLK SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:BRASSTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:28902-8056
Mailing Address - Country:US
Mailing Address - Phone:828-837-3253
Mailing Address - Fax:
Practice Address - Street 1:538 FOLK SCHOOL RD
Practice Address - Street 2:
Practice Address - City:BRASSTOWN
Practice Address - State:NC
Practice Address - Zip Code:28902-8056
Practice Address - Country:US
Practice Address - Phone:828-837-3253
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL001351133V00000X
GALD002795133V00000X
TNLDN0000001552133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC140YUOtherBLUE CROSS BLUE SHIELD NC
NC2994237Medicare ID - Type UnspecifiedMEDICARE PART B PROGRAM