Provider Demographics
NPI:1730208133
Name:ASHIDA-ANDERSON, SUSAN (RD, LD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:ASHIDA-ANDERSON
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 N ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-4853
Mailing Address - Country:US
Mailing Address - Phone:620-353-3781
Mailing Address - Fax:
Practice Address - Street 1:8533 E 32ND ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2611
Practice Address - Country:US
Practice Address - Phone:316-293-2622
Practice Address - Fax:855-517-9494
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS000950133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS130585Medicare ID - Type UnspecifiedMEDICARE PROVIDER