Provider Demographics
NPI:1588853097
Name:KRUPENEVICH, SUSAN L (RD, LD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:KRUPENEVICH
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2244 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2430
Mailing Address - Country:US
Mailing Address - Phone:757-315-3682
Mailing Address - Fax:
Practice Address - Street 1:2244 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2430
Practice Address - Country:US
Practice Address - Phone:757-315-3682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-20
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV371133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered