Provider Demographics
NPI:1235599853
Name:INDERGAARD, SARAH (RD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:INDERGAARD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:COULTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:3900 ALABAMA AVE S
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2819
Mailing Address - Country:US
Mailing Address - Phone:402-658-6120
Mailing Address - Fax:
Practice Address - Street 1:2265 COMO AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-1737
Practice Address - Country:US
Practice Address - Phone:651-645-5323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-24
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3670133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered