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General NPI Number Information
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NPI Number | 1538155502
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Entity Type | Individual
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Provider Name | SARAH FAYE MABARY RD LD
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Gender | Female
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Dates
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Enumeration Date | 09/23/2005
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Last Update Date | 06/14/2016
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Provider Practice Location Address
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Address Line | 1584 420TH ST
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City | EMERSON
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State | IA
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Zip | 51533-6029
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Country | US
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Telephone | 712-824-7570
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Fax |
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Provider Business Mailing Address
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Address Line | 1584 420TH ST
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City | EMERSON
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State | IA
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Zip | 51533-6029
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Country | US
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Telephone | 712-824-7570
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 00601
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 805482
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License Number State | IA
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