Provider Demographics
NPI:1699100826
Name:SOMMERS, SARAH ANN (RD, LD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ANN
Last Name:SOMMERS
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 W 5TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-2752
Mailing Address - Country:US
Mailing Address - Phone:370-675-2640
Mailing Address - Fax:307-675-4639
Practice Address - Street 1:1333 W 5TH ST STE 112
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2752
Practice Address - Country:US
Practice Address - Phone:370-675-2640
Practice Address - Fax:307-675-4639
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY126133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
1081398OtherRD CREDENTIAL