Provider Demographics
NPI:1679346415
Name:GEIGER, SARA BLAKE (RDN)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:BLAKE
Last Name:GEIGER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 EAST BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-6158
Mailing Address - Country:US
Mailing Address - Phone:980-288-4978
Mailing Address - Fax:
Practice Address - Street 1:1218 EAST BLVD STE G
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-6158
Practice Address - Country:US
Practice Address - Phone:980-288-4978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL007477133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered