Provider Demographics
NPI:1154638997
Name:SAURO, HEATHER LUCAS (RD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LUCAS
Last Name:SAURO
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 1:221 BLUE HERON LN
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-9430
Mailing Address - Country:US
Mailing Address - Phone:406-830-0001
Mailing Address - Fax:
Practice Address - Street 1:221 BLUE HERON LN
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-9430
Practice Address - Country:US
Practice Address - Phone:406-830-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT569133V00000X
MA2624133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered