Provider Demographics
NPI:1396706727
Name:LARNER, SUSAN LYNDAL (RD CDE)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:LYNDAL
Last Name:LARNER
Suffix:
Gender:F
Credentials:RD CDE
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:LYNDAL
Other - Last Name:MENCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007
Mailing Address - Country:US
Mailing Address - Phone:269-341-8252
Mailing Address - Fax:269-341-7518
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007
Practice Address - Country:US
Practice Address - Phone:269-341-8252
Practice Address - Fax:269-341-7518
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI368275133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered