Provider Demographics
NPI:1609334739
Name:RAATZ, SUSAN KAY (RD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:KAY
Last Name:RAATZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 LINWOOD AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-3399
Mailing Address - Country:US
Mailing Address - Phone:612-385-2567
Mailing Address - Fax:
Practice Address - Street 1:1539 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-2229
Practice Address - Country:US
Practice Address - Phone:833-833-2590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1747133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1747OtherBOARD OF DIETETICS AND NUTRITION PRACTICE