MEDICARE: MS. SUSAN BURKY MICHELI MS, RD, CDE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1104944826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN BURKY MICHELI MS, RD, CDE

Provider Business Mailing Address
First Line	:	1510 POOLE BLVD STE 106
Second Line	:
City	:	YUBA CITY
State	:	CA
Zip	:	95993-2607
Country	:	US
Telephone Number	:	530-671-2848
Fax Number	:

Provider Business Practice Location Address
First Line	:	1510 POOLE BLVD STE 106
Second Line	:
City	:	YUBA CITY
State	:	CA
Zip	:	95993-2607
Country	:	US
Telephone Number	:	530-671-2848
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	07/08/2007

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