Provider Demographics
NPI:1073701884
Name:WIDENER, SARAH (RD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:WIDENER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 FAIRVIEW AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-4914
Mailing Address - Country:US
Mailing Address - Phone:270-901-3412
Mailing Address - Fax:270-901-3413
Practice Address - Street 1:843 FAIRVIEW AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-4914
Practice Address - Country:US
Practice Address - Phone:270-901-3412
Practice Address - Fax:270-901-3413
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-05
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1695133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered