Healthcare Provider Details

I. General information

NPI: 1588253405
Provider Name (Legal Business Name): SARAH UNDERRINER-WEBER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2021
Last Update Date: 03/26/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR # B7500
FORT CARSON CO
80913-4613
US

IV. Provider business mailing address

EVANS ARMY COMMUNITY HOSPITAL, 1650 COCHRANE CIR B7500
FORT CARSON CO
80913-3400
US

V. Phone/Fax

Practice location:
  • Phone: 719-756-6505
  • Fax:
Mailing address:
  • Phone: 719-756-6505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number96702
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number960942
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: