Healthcare Provider Details

I. General information

NPI: 1922372499
Provider Name (Legal Business Name): SARA ZOOK RD, CD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2012
Last Update Date: 07/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 PARK AVE COLUMBUS COMMUNITY HOSPITAL, NUTRITION SERVICES
COLUMBUS WI
53925-1618
US

IV. Provider business mailing address

1515 PARK AVE COLUMBUS COMMUNITY HOSPITAL
COLUMBUS WI
53925-1618
US

V. Phone/Fax

Practice location:
  • Phone: 920-623-1545
  • Fax: 920-623-1250
Mailing address:
  • Phone: 920-623-1545
  • Fax: 920-623-1250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1781-29
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: