Provider Demographics
NPI:1457809725
Name:BRUNELLE, SARAH MARGARET CARSON
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MARGARET CARSON
Last Name:BRUNELLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PENHOW CIR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-2582
Mailing Address - Country:US
Mailing Address - Phone:970-231-1688
Mailing Address - Fax:
Practice Address - Street 1:200 PENHOW CIR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-2582
Practice Address - Country:US
Practice Address - Phone:970-231-1688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1079795133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered