MEDICARE: MRS. SUZANNE MARIE BLEVINS RDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	912920	AZ

General Provider Information

NPI Number	:	1144762345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUZANNE MARIE BLEVINS RDN

Provider Business Mailing Address
First Line	:	7410 N PATRIOT DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85741-2128
Country	:	US
Telephone Number	:	520-603-5175
Fax Number	:

Provider Business Practice Location Address
First Line	:	7410 N PATRIOT DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85741-2128
Country	:	US
Telephone Number	:	520-603-5175
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2016
Last Update Date	:	11/06/2016

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