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Individual

SUSAN LYNN SMITH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.B.A., R.D.

Contact information

Practice address
3651 KAKELA MAKAI DRIVE, KALAHEO, HI 96741-0411
(808) 212-4657
Mailing address
PO BOX 411, KALAHEO, HI 96741-0411
(808) 212-4657

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
722149

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
722149
CREDENTIALING AGENCY OF THE AMERICAN DIETETIC ASSOCIATION
Enumeration date
03/02/2011
Last updated
03/02/2011
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