Provider Demographics
NPI:1972334340
Name:JACKSON, SARAH KRISTEN (MS)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:KRISTEN
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2915 ARBORVIEW DR APT 12
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49685-6733
Mailing Address - Country:US
Mailing Address - Phone:516-512-2663
Mailing Address - Fax:
Practice Address - Street 1:2915 ARBORVIEW DR APT 12
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49685-6733
Practice Address - Country:US
Practice Address - Phone:516-512-2663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist