Provider Demographics
NPI:1023626108
Name:YARROW, SAMUEL BRYAN (MS, RD, LD)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:BRYAN
Last Name:YARROW
Suffix:
Gender:M
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 E MONTCLAIR ST APT 2D
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-7931
Mailing Address - Country:US
Mailing Address - Phone:515-988-2624
Mailing Address - Fax:
Practice Address - Street 1:960 E WALNUT LAWN ST STE 203
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-7865
Practice Address - Country:US
Practice Address - Phone:417-269-3904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered