MEDICARE: SARAH DIANA RDN

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

General Provider Information

NPI Number	:	1548845464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH DIANA RDN

Provider Business Mailing Address
First Line	:	4215 S 30TH ST APT 335
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98409-3244
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9040A JACKSON AVENUE
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98431-1702
Country	:	US
Telephone Number	:	253-968-6337
Fax Number	:

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

Provider Enumeration Date	:	03/11/2021
Last Update Date	:	08/03/2021

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Directions to “ SARAH DIANA RDN” Practice Location

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