Provider Demographics
NPI:1699937920
Name:KOERTNER, SUSAN E (RD, LD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:KOERTNER
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:E
Other - Last Name:ARIKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:1915 HICKORY CHASE DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-5052
Mailing Address - Country:US
Mailing Address - Phone:281-829-2267
Mailing Address - Fax:
Practice Address - Street 1:1915 HICKORY CHASE DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-5052
Practice Address - Country:US
Practice Address - Phone:281-829-2267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT07676133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered