Healthcare Provider Details

I. General information

NPI: 1174996292
Provider Name (Legal Business Name): SARA WHITNEY YOUNG RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2015
Last Update Date: 06/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040A JACKSON AVE
TACOMA WA
98431-0001
US

IV. Provider business mailing address

401 BROADWAY STE 100
TACOMA WA
98402-3900
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-0547
  • Fax:
Mailing address:
  • Phone: 206-880-3668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI60609985
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: