Provider Demographics
NPI:1720631773
Name:NEARY, SARAH (RD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:NEARY
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 1:3522 HALF MOON AVE SW
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:IA
Mailing Address - Zip Code:52340-9337
Mailing Address - Country:US
Mailing Address - Phone:712-560-2801
Mailing Address - Fax:
Practice Address - Street 1:3522 HALF MOON AVE SW
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:IA
Practice Address - Zip Code:52340-9337
Practice Address - Country:US
Practice Address - Phone:712-560-2801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA085700133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered