SUSAN BROECKELMAN (NPI# 1518148071) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518148071 |
| Entity Type | Individual |
| Full Name | SUSAN BROECKELMAN |
| Practice Address |
100 Crestvue Ave Mankato KS 66956-2407 |
| Practice Telephone | 7853783137 |
| Mailing Telephone | 7853783137 |
| Enumeration Date | 2007-11-26 |
| Last Update Date | 2007-11-26 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 133V00000X | Dietitian, Registered | 829 | KS | Dietary & Nutritional Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CDR ID NUMBER | 708146 | 01 |
| Street Address |
100 CRESTVUE AVE |
| City | MANKATO |
| State | KS |
| Zip Code | 66956-2407 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336184647 | Jewell County Hospital | General Acute Care Hospital | 100 Crestvue Ave, Mankato, KS 66956-2407 | 2006-06-19 |
| 1447418827 | Jewell County Hospital | General Practice | 100 Crestvue Ave, Mankato, KS 66956-2407 | 2008-06-02 |
| 1932131026 | Jewell County Hospital Ltc | Nursing Facility/Intermediate Care Facility | 100 Crestvue Ave, Mankato, KS 66956-2407 | 2006-07-07 |
| 1649209552 | Danielle Bohl | Physical Therapist | 100 Crestvue Ave, Mankato, KS 66956-2407 | 2006-07-02 |
| 1811925290 | Jewell County Hospital | Medicare Defined Swing Bed Unit | 100 Crestvue Ave, Mankato, KS 66956-2407 | 2006-06-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750361754 | John W Bleecker | Dentist | 123 N Commercial, Mankato, KS 66956 | 2006-01-18 |
| 1275519613 | County of Jewell | Ambulance | 510 E North St, Mankato, KS 66956-1850 | 2005-12-19 |
| 1760487656 | County of Jewell | Public Health or Welfare | 307 N Commercial St Ste 2, Mankato, KS 66956-2025 | 2005-06-16 |
| 1508182916 | John R Tyler | Chiropractor | 201 N Commercial St, Mankato, KS 66956-2028 | 2010-04-09 |
| 1609815364 | Leon Hughes | Physician Assistant | 102 S Center St, Mankato, KS 66956-2202 | 2006-06-06 |
| 1134157514 | Marilyn Dunstan | Nurse Practitioner | 102 S Center St, Mankato, KS 66956-2202 | 2006-06-28 |
| 1386689586 | Jewell County Hospital | Clinic/Center | 102 S Center St, Mankato, KS 66956-2202 | 2006-06-19 |
| 1497741748 | Dauner Pharmacies Chtd | Pharmacy | 125 N Commercial St, Mankato, KS 66956-2206 | 2005-09-22 |
| 1285779371 | Lyle R Dauner | Pharmacist | 125 N Commercial St, Mankato, KS 66956-2206 | 2007-02-20 |
| 1306079686 | Usd 107 | Local Education Agency (LEA) | 109 E Main St, Mankato, KS 66956-2214 | 2009-09-02 |
| Find all providers in zip 66956 | ||||
| Taxonomy Code | 133V00000X |
| Grouping | Dietary & Nutritional Service Providers |
| Classification | Dietitian, Registered |
| A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor’s degree at a US regionally accredited university or college and course work approved by The American Dietetic Association (ADA); an ADA-accredited or approved, supervised practice program, typically 6 to 12 months in length; a national examination administered by the Commission on Dietetic Registration; and continuing professional educational requirements to maintain registration. |
| Notes: Source: The American Dietetic Association. Becoming a Registered Dietitian – a food and nutrition expert. Chicago, IL: The American Dietetic Association, July 1997. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295138469 | Britni Vincent | Dietitian, Registered | 58192 191st Ln, Mankato, MN 56001-7892 | 2014-10-02 |
| 1912471665 | Abby Jo Tibodeau | Dietitian, Registered | 1230 E Main St, Mankato, MN 56001-5066 | 2019-01-16 |
| 1659883411 | Jessica Lynn Weisbrich | Dietitian, Registered | 1025 Marsh St, Mankato, MN 56001-4752 | 2017-11-01 |
| 1477080851 | Evora Rochelle Sinclair Liddell | Dietitian, Registered | 309 Holly Ln, Mankato, MN 56001-5422 | 2017-05-17 |
| 1760847396 | Kelly Tasky | Dietitian, Registered | 1025 Marsh St, Mankato, MN 56001-4752 | 2015-12-26 |
| 1659770147 | Erin Braun | Dietitian, Registered | 1230 E Main St, Mankato, MN 56001-5066 | 2014-08-20 |
| 1891136446 | Nicole Christine Streich | Dietitian, Registered | 1025 Marsh St, Mankato, MN 56001 | 2013-07-11 |
| 1265704001 | Roxanna Lynne Padilla | Dietitian, Registered | 1025 Marsh St, Mankato, MN 56001-4752 | 2012-02-08 |
| 1891096491 | Grace A Fjeldberg | Dietitian, Registered | 1025 Marsh St, Mankato, MN 56001-4752 | 2010-11-12 |
| 1861647372 | April Lynn Graff | Dietitian, Registered | 2010 Adams St, Mankato, MN 56001-6817 | 2008-11-25 |
| Find all providers in MANKATO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.