Provider Demographics
NPI:1508302464
Name:SASSER, DONNA (RD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:SASSER
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 1:280 HIGHWAY 556
Mailing Address - Street 2:
Mailing Address - City:CHOUDRANT
Mailing Address - State:LA
Mailing Address - Zip Code:71227-3247
Mailing Address - Country:US
Mailing Address - Phone:318-768-4357
Mailing Address - Fax:
Practice Address - Street 1:1015 UNITY RD
Practice Address - Street 2:
Practice Address - City:CROSSETT
Practice Address - State:AR
Practice Address - Zip Code:71635-9443
Practice Address - Country:US
Practice Address - Phone:870-364-1419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-16
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR473133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered