Healthcare Provider Details

I. General information

NPI: 1780771121
Provider Name (Legal Business Name): SUZANNE SCHOBY RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 N WABASH AVE
MARION IN
46952-2612
US

IV. Provider business mailing address

441 N WABASH AVE
MARION IN
46952-2612
US

V. Phone/Fax

Practice location:
  • Phone: 765-662-4396
  • Fax: 765-671-3098
Mailing address:
  • Phone: 765-662-4396
  • Fax: 765-671-3098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number37001730A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: