Provider Demographics
NPI:1518628643
Name:WILSON, SARIAH E (RD)
Entity Type:Individual
Prefix:
First Name:SARIAH
Middle Name:E
Last Name:WILSON
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 1:6040 S CHINOOK WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-1378
Mailing Address - Country:US
Mailing Address - Phone:801-857-0390
Mailing Address - Fax:
Practice Address - Street 1:13900 W WAINWRIGHT DR STE 103
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-5028
Practice Address - Country:US
Practice Address - Phone:801-857-0390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-1296133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered