Healthcare Provider Details

I. General information

NPI: 1316493208
Provider Name (Legal Business Name): SARA BERRETH RDN, LN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARA MEYER RDN, LN

II. Dates (important events)

Enumeration Date: 08/30/2016
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 9TH AVE NW
WATERTOWN SD
57201-1548
US

IV. Provider business mailing address

401 9TH AVE NW
WATERTOWN SD
57201-1548
US

V. Phone/Fax

Practice location:
  • Phone: 605-882-7874
  • Fax: 605-882-5443
Mailing address:
  • Phone: 605-882-7874
  • Fax: 605-882-5443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86018924
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: