| Doctor Name: | MRS. SUSAN MARIE MANTERNACH |
| NPI Number: | 1073792644 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RD,LD,CDDE |
| License Number: | 00564 |
| Business Practice Address: | 1560 University Ave Dubuque, IA - 520014790 |
| Business Phone Number: | 5635894899 |
| Business Fax Number: | 5635894897 |
| Mailing Address: | 1560 University Ave, DUBUQUE |
| State: | IA |
| Postal Code: | 520014790 |
| Phone Number: | 5635894899 |
| Fax Number: | 5635894897 |
| NPI Enumeration Date: | 10/30/2007 |
| NPI Last Update Date: | 10/30/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133VN1006X |
| License Number: | 00564 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IA |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | Nutrition, Metabolic |
| Taxonomy Definition: | |