Healthcare Provider Details

I. General information

NPI: 1932577947
Provider Name (Legal Business Name): SUSAN TESKE MS, RD, CNSC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2015
Last Update Date: 09/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 7TH AVE S
BIRMINGHAM AL
35233-1711
US

IV. Provider business mailing address

6470 WOMACK RD
PINSON AL
35126-3176
US

V. Phone/Fax

Practice location:
  • Phone: 205-638-7475
  • Fax: 205-638-7995
Mailing address:
  • Phone: 205-681-5093
  • Fax: 205-638-7995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number114
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: