Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 1145 | OH |
NPI | 1427266600 |
---|---|
Provider Name | Dr. Susan Hendricks Pezzin |
First Address | Toledo, OH 43615-5989 |
Second Address | Toledo, OH 43615-5989 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2007 |
Last Update Date | 08/07/2007 |