Provider Demographics
NPI:1821137480
Name:FOREMAN, SARA WILKINSON (RD, LDN, CDE)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:WILKINSON
Last Name:FOREMAN
Suffix:
Gender:F
Credentials:RD, LDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 RIVERSHORE RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-6214
Mailing Address - Country:US
Mailing Address - Phone:252-331-2716
Mailing Address - Fax:
Practice Address - Street 1:2108 RIVERSHORE RD
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-6214
Practice Address - Country:US
Practice Address - Phone:252-331-2716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL00160133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered