Healthcare Provider Details

I. General information

NPI: 1407258924
Provider Name (Legal Business Name): SARAH HULTS RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2014
Last Update Date: 09/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 W FULTON ST
CHICAGO IL
60612-2345
US

IV. Provider business mailing address

1242 W DIVERSEY PKWY APT 2
CHICAGO IL
60614-1202
US

V. Phone/Fax

Practice location:
  • Phone: 312-850-3438
  • Fax:
Mailing address:
  • Phone: 847-715-6644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164005942
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: