| Doctor Name: | MRS. SUSAN DETHMAN |
| NPI Number: | 1356340442 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CDR |
| License Number: | T202394 |
| Business Practice Address: | Hwy 56 & 270 Junction Wewoka, OK - 74884 |
| Business Phone Number: | 4052577318 |
| Business Fax Number: | 4052572696 |
| Mailing Address: | Po Box 1475, WEWOKA |
| State: | OK |
| Postal Code: | 748841475 |
| Phone Number: | 4052577318 |
| Fax Number: | 4052572696 |
| NPI Enumeration Date: | 07/20/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | T202394 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |