MEDICARE: SUSAN ELIZABETH KOUZEL RD

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		VA
2	133V00000X	Registered Dietitian	86052683	VA

General Provider Information

NPI Number	:	1538600366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN ELIZABETH KOUZEL RD

Provider Business Mailing Address
First Line	:	115 HAMPSHIRE SQ SW
Second Line	:
City	:	LEESBURG
State	:	VA
Zip	:	20175-5036
Country	:	US
Telephone Number	:	703-431-6892
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 HAMPSHIRE SQ SW
Second Line	:
City	:	LEESBURG
State	:	VA
Zip	:	20175-5036
Country	:	US
Telephone Number	:	703-431-6892
Fax Number	:

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

Provider Enumeration Date	:	03/13/2017
Last Update Date	:	09/01/2024

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