Healthcare Provider Details

I. General information

NPI: 1992020705
Provider Name (Legal Business Name): SUSAN MARIE MEESE-MORRIS RD, CSR, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2010
Last Update Date: 04/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 NW 70TH AVE STE 107
PLANTATION FL
33317-2358
US

IV. Provider business mailing address

9491 OAK GROVE CIR
DAVIE FL
33328-6939
US

V. Phone/Fax

Practice location:
  • Phone: 954-581-0200
  • Fax:
Mailing address:
  • Phone: 954-205-5462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberND3293
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: