Healthcare Provider Details

I. General information

NPI: 1801127055
Provider Name (Legal Business Name): HEATHER SUTPHEN CAMPBELL MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEATHER MARIE SUTPHEN MS, RD, LD

II. Dates (important events)

Enumeration Date: 01/27/2010
Last Update Date: 12/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 LONGWOOD TRL
PIKE ROAD AL
36064-2720
US

IV. Provider business mailing address

406 LONGWOOD TRL
PIKE ROAD AL
36064-2720
US

V. Phone/Fax

Practice location:
  • Phone: 402-981-1844
  • Fax:
Mailing address:
  • Phone: 402-981-1844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: