Healthcare Provider Details

I. General information

NPI: 1447349204
Provider Name (Legal Business Name): SUSAN REAMS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 6TH AVE DIETARY OFFICE
DES MOINES IA
50314-2610
US

IV. Provider business mailing address

1055 6TH AVE SUITE 200
DES MOINES IA
50314-2607
US

V. Phone/Fax

Practice location:
  • Phone: 515-643-2508
  • Fax:
Mailing address:
  • Phone: 515-643-8672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number00450
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: