Healthcare Provider Details

I. General information

NPI: 1639461619
Provider Name (Legal Business Name): SARAH ELIZABETH FLINN LARSON MS, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2011
Last Update Date: 11/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 METACOM AVE
BRISTOL RI
02809-5131
US

IV. Provider business mailing address

685 METACOM AVE
BRISTOL RI
02809-5131
US

V. Phone/Fax

Practice location:
  • Phone: 401-396-9331
  • Fax: 401-396-9369
Mailing address:
  • Phone: 401-396-9331
  • Fax: 401-396-9369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number3044
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3044
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLDN00754
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: