Provider Demographics
NPI:1912493412
Name:KELLER, SARAH BETH (RD)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:BETH
Last Name:KELLER
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 1:2585 ARGYLE RD
Mailing Address - Street 2:
Mailing Address - City:SNOVER
Mailing Address - State:MI
Mailing Address - Zip Code:48472-9336
Mailing Address - Country:US
Mailing Address - Phone:734-648-5034
Mailing Address - Fax:
Practice Address - Street 1:2585 ARGYLE RD
Practice Address - Street 2:
Practice Address - City:SNOVER
Practice Address - State:MI
Practice Address - Zip Code:48472-9336
Practice Address - Country:US
Practice Address - Phone:734-648-5034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-08
Last Update Date:2018-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI86061394133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered