Provider Demographics
NPI:1740558428
Name:EADES WADE, SARA E (MS, RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:E
Last Name:EADES WADE
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:E
Other - Last Name:EADES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1020 E 1150 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:BEMENT
Mailing Address - State:IL
Mailing Address - Zip Code:61813-3510
Mailing Address - Country:US
Mailing Address - Phone:217-840-9464
Mailing Address - Fax:
Practice Address - Street 1:1000 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IL
Practice Address - Zip Code:61856-2116
Practice Address - Country:US
Practice Address - Phone:217-762-1904
Practice Address - Fax:217-762-1905
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.005589133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered