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General NPI Number Information
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NPI Number | 1912982653
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Entity Type | Individual
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Provider Name | SUSAN T. SEYKORA R.D., L.D.
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Gender | Female
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Dates
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Enumeration Date | 12/14/2005
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Last Update Date | 09/17/2020
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Provider Practice Location Address
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Address Line | 501 N STATE ST WASECA MEDICAL CENTER - MAYO HEALTH SYSTEM
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City | WASECA
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State | MN
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Zip | 56093
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Country | US
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Telephone | 507-835-1210
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Fax | 507-837-4280
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Provider Business Mailing Address
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Address Line | 501 N STATE ST WASECA MEDICAL CENTER - MAYO HEALTH SYSTEM
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City | WASECA
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State | MN
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Zip | 56093
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Country | US
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Telephone | 507-835-1210
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Fax | 507-837-4280
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 727534
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License Number State | MN
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