Provider Demographics
NPI:1952901803
Name:TEFFT, SARA MARIE (RD, LD, LMNT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:MARIE
Last Name:TEFFT
Suffix:
Gender:F
Credentials:RD, LD, LMNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 NE 18TH ST UNIT 96
Mailing Address - Street 2:
Mailing Address - City:GRIMES
Mailing Address - State:IA
Mailing Address - Zip Code:50111-4735
Mailing Address - Country:US
Mailing Address - Phone:641-425-6629
Mailing Address - Fax:
Practice Address - Street 1:2150 NE 18TH ST UNIT 96
Practice Address - Street 2:
Practice Address - City:GRIMES
Practice Address - State:IA
Practice Address - Zip Code:50111-4735
Practice Address - Country:US
Practice Address - Phone:641-425-6629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1516133V00000X
IA099603133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered