Provider Demographics
NPI:1659889418
Name:RAVI-JOHNSON, SARA LOUISE (RD, CD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:LOUISE
Last Name:RAVI-JOHNSON
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 108TH ST SW
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-3773
Mailing Address - Country:US
Mailing Address - Phone:503-277-8814
Mailing Address - Fax:
Practice Address - Street 1:3203 206TH PL SW
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-7817
Practice Address - Country:US
Practice Address - Phone:425-409-3544
Practice Address - Fax:425-354-3544
Is Sole Proprietor?:No
Enumeration Date:2018-01-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60812141133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered