Provider Demographics
NPI:1447547690
Name:RESNECK-FISCH, SUSAN ELIZABETH (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:RESNECK-FISCH
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ELIZABETH
Other - Last Name:RESNECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF NEW MEXICO 1 UNIVERSITY OF NM
Mailing Address - Street 2:BUILDING 73, MSC06 3870
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-277-1074
Mailing Address - Fax:505-277-2020
Practice Address - Street 1:UNIVERSITY OF NEW MEXICO 1 UNIVERSITY OF NM
Practice Address - Street 2:BUILDING 73, MSC06 3870
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-277-1074
Practice Address - Fax:505-277-2020
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLD-0691133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered