Healthcare Provider Details

I. General information

NPI: 1710780242
Provider Name (Legal Business Name): MS. SARA ELLEN TIEFENTHALER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 03/31/2025
Certification Date: 03/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11809 HINSON RD STE 400
LITTLE ROCK AR
72212-3470
US

IV. Provider business mailing address

11809 HINSON RD STE 400
LITTLE ROCK AR
72212-3470
US

V. Phone/Fax

Practice location:
  • Phone: 501-305-0424
  • Fax:
Mailing address:
  • Phone: 501-305-0424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: