Provider Demographics
NPI:1508350943
Name:FREEMAN, SARA TIKKER (RDN, LD, CNSC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:TIKKER
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:RDN, LD, CNSC
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:EMILY
Other - Last Name:TIKKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN, LD, CNSC
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:520 S EAGLE RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6351
Practice Address - Country:US
Practice Address - Phone:208-706-1462
Practice Address - Fax:208-706-4107
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-993133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered