MEDICARE: SARAH WRIGHT RD, LDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	164.007206	IL

General Provider Information

NPI Number	:	1578144325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH WRIGHT RD, LDN

Provider Business Mailing Address
First Line	:	5221 BUFORD ST
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62703-5304
Country	:	US
Telephone Number	:	217-891-8393
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 W WALNUT ST
Second Line	:
City	:	JACKSONVILLE
State	:	IL
Zip	:	62650-1199
Country	:	US
Telephone Number	:	217-479-3875
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2021
Last Update Date	:	04/14/2021

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Directions to “ SARAH WRIGHT RD, LDN” Practice Location

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