Individual
MS. SUSAN M PARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD,CSSD,LDN,CPT
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
N153
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0063-0001350
MEDICA
MN
01
—
400A3PA
BLUE CROSS BLUE SHIELD
MN
Enumeration date
04/11/2007
Last updated
07/14/2014
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