Provider Demographics
NPI:1275260796
Name:SPENCER, SARAH LYN (MS, RDN)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LYN
Last Name:SPENCER
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:MRS
Other - First Name:SARAH
Other - Middle Name:LYN
Other - Last Name:EDDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RDN
Mailing Address - Street 1:100 MICHIGAN ST NE # MC845
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:35 MICHIGAN ST NE STE 5201
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2530
Practice Address - Country:US
Practice Address - Phone:616-267-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI86085302133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI86085302OtherCOMMISSION ON DIETETIC REGISTRATION