Provider Demographics
NPI:1790735116
Name:PETRICK, SARAH A (RD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:A
Last Name:PETRICK
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 1:323 SUNSET DR STE 2
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-4017
Mailing Address - Country:US
Mailing Address - Phone:724-282-2730
Mailing Address - Fax:724-282-3004
Practice Address - Street 1:323 SUNSET DR STE 2
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-4017
Practice Address - Country:US
Practice Address - Phone:724-282-2730
Practice Address - Fax:724-282-3004
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003498133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADN003498OtherDIETITIAN-NUTRITIONIST
PADN003498OtherDIETITIAN-NUTRITIONIST