MEDICARE: SARAH ELIZABETH HIGGINS RDN, CSO, LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	LD.7454	OH

General Provider Information

NPI Number	:	1528820263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH ELIZABETH HIGGINS RDN, CSO, LD

Provider Business Mailing Address
First Line	:	38033 VISTA LAKE WAY
Second Line	:
City	:	NORTH RIDGEVILLE
State	:	OH
Zip	:	44039-5132
Country	:	US
Telephone Number	:	330-719-6405
Fax Number	:

Provider Business Practice Location Address
First Line	:	38033 VISTA LAKE WAY
Second Line	:
City	:	NORTH RIDGEVILLE
State	:	OH
Zip	:	44039-5132
Country	:	US
Telephone Number	:	330-719-6405
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2024
Last Update Date	:	01/29/2024

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