Provider Demographics
NPI:1932274263
Name:MORVICH, SUSAN LEE (RD LD BS BA)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LEE
Last Name:MORVICH
Suffix:
Gender:F
Credentials:RD LD BS BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12327 REND CITY ROAD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:IL
Mailing Address - Zip Code:62812
Mailing Address - Country:US
Mailing Address - Phone:618-927-5079
Mailing Address - Fax:
Practice Address - Street 1:2401 W MAIN STREET RM 113 NHCU
Practice Address - Street 2:VETERANS ADMINISTRATION MEDICAL CENTER
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959
Practice Address - Country:US
Practice Address - Phone:618-997-5311
Practice Address - Fax:618-998-5671
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered