Provider Demographics
NPI:1144782228
Name:MONTGOMERY, SARAH RASHELLE (MS, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:RASHELLE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:MRS
Other - First Name:SARAH
Other - Middle Name:RASHELLE
Other - Last Name:MONTGOMERY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:17 TERRELL LN
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:NV
Mailing Address - Zip Code:89444-9572
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17 TERRELL LN
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:NV
Practice Address - Zip Code:89444-9572
Practice Address - Country:US
Practice Address - Phone:949-616-5912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-05
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV133N00000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist