Healthcare Provider Details

I. General information

NPI: 1073918421
Provider Name (Legal Business Name): SUSAN WOHLBACH LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2014
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 SAINT CHARLES WAY
YORK PA
17402-4648
US

IV. Provider business mailing address

3421 CONCORD RD
YORK PA
17402-9001
US

V. Phone/Fax

Practice location:
  • Phone: 717-851-6231
  • Fax: 717-741-1719
Mailing address:
  • Phone: 717-851-1405
  • Fax: 717-851-6969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN000472
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDN000472
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: