Provider Demographics
NPI:1457646754
Name:EBER, SARAH JEANNE (LD RD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JEANNE
Last Name:EBER
Suffix:
Gender:F
Credentials:LD RD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:JEANNE
Other - Last Name:OLIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPH RD LD CDE
Mailing Address - Street 1:1801 CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6015
Mailing Address - Country:US
Mailing Address - Phone:660-349-8881
Mailing Address - Fax:
Practice Address - Street 1:3400 W TRUMAN BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-5712
Practice Address - Country:US
Practice Address - Phone:660-349-8881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001001337133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered