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NPI Code Detail

MEDICARE: MRS. SUZANNE DENISE MCCOMB R.D.

MEDICARE: MRS. SUZANNE DENISE MCCOMB R.D.
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
1133V00000XRegistered Dietitian2008031157MO

General Provider Information

NPI Number : 1952636631
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SUZANNE DENISE MCCOMB R.D.
Provider Business Mailing Address
First Line : 1379 SCHOAL CREEK DR
Second Line :
City : SAINT PETERS
State : MO
Zip : 63366-3605
Country : US
Telephone Number : 636-541-2686
Fax Number :
Provider Business Practice Location Address
First Line : 6065 HELEN AVE
Second Line :
City : BERKELEY
State : MO
Zip : 63134-2013
Country : US
Telephone Number : 314-522-6410
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2009
Last Update Date : 10/13/2009

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