Healthcare Provider Details

I. General information

NPI: 1730504184
Provider Name (Legal Business Name): SARA ELIZABETH KUHN RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2014
Last Update Date: 02/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 NE FRANKLIN AVE SUITE #5
BEND OR
97701-4959
US

IV. Provider business mailing address

61797 FARGO LN
BEND OR
97702-2457
US

V. Phone/Fax

Practice location:
  • Phone: 541-323-3488
  • Fax:
Mailing address:
  • Phone: 419-654-1494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD-D-000998
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: