Provider Demographics
NPI:1730170317
Name:HOELSCHER, SUSAN R (RD)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:R
Last Name:HOELSCHER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:R
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 600
Mailing Address - Street 2:
Mailing Address - City:TUBA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86045-0600
Mailing Address - Country:US
Mailing Address - Phone:928-863-7333
Mailing Address - Fax:505-368-6431
Practice Address - Street 1:6300 N HIGHWAY 89
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004
Practice Address - Country:US
Practice Address - Phone:928-863-7333
Practice Address - Fax:928-527-2995
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM558133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM47683830Medicaid
Q10914Medicare UPIN
320059Medicare Oscar/Certification
NM47683830Medicaid