Provider Demographics
NPI:1275304842
Name:STEPHENS, SARAH LOUISE (MS, RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:LOUISE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 PARKWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-6536
Mailing Address - Country:US
Mailing Address - Phone:910-617-5974
Mailing Address - Fax:
Practice Address - Street 1:510 CAROLINA BAY DR STE 200
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2046
Practice Address - Country:US
Practice Address - Phone:910-662-8937
Practice Address - Fax:910-777-5031
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005316133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered