Provider Demographics
NPI:1013781616
Name:HENLEY, SARA (RD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:HENLEY
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 1:4112 ZENOBIA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-2236
Mailing Address - Country:US
Mailing Address - Phone:610-662-6144
Mailing Address - Fax:
Practice Address - Street 1:4112 ZENOBIA ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80212-2236
Practice Address - Country:US
Practice Address - Phone:610-662-6144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86169962133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered