Provider Demographics
NPI:1083918387
Name:LOPINSKI, SARA A (RD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:A
Last Name:LOPINSKI
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 19644
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62794-9644
Mailing Address - Country:US
Mailing Address - Phone:217-545-3821
Mailing Address - Fax:217-545-9125
Practice Address - Street 1:751 N RUTLEDGE ST
Practice Address - Street 2:SUITE 2300
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-4968
Practice Address - Country:US
Practice Address - Phone:217-545-3821
Practice Address - Fax:217-545-9125
Is Sole Proprietor?:No
Enumeration Date:2010-12-29
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164000239133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL256510112Medicare PIN