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General NPI Number Information
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NPI Number | 1891460572
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Entity Type | Organization
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Legal Business Name | SARAH PITTMAN NUTRITION, LLC
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Dates
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Enumeration Date | 08/13/2021
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Last Update Date | 08/13/2021
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Provider Practice Location Address
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Address Line | 2009 PARKDALE DR
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City | CHAMPAIGN
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State | IL
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Zip | 61821-5459
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Country | US
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Telephone | 217-418-0795
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Fax |
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Provider Business Mailing Address
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Address Line | 2009 PARKDALE DR
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City | CHAMPAIGN
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State | IL
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Zip | 61821-5459
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Country | US
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Telephone | 217-418-0795
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Fax |
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Authorized Official
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Title or Position | REGISTERED DIETITIAN
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Name | SARAH PITTMAN
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Credential | MS, RD, LDN
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Telephone | 217-418-0795
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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