NPI 1194196667 · live from the CMS NPI Registry
Sarah J Peterson, RD
Dietitian, Registered in Jackson, WY. National Provider Identifier 1194196667, active.
NPI record
| NPI | 1194196667 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dietitian, Registered 133V00000X |
| Practice location | 555 E Broadway Ave, Ste 201, Jackson, WY 83001 |
| Practice phone | 307-739-7634 |
| Mailing address | Po Box 428, Jackson, WY 83001 |
| Enumerated | October 9, 2015 |
| Last updated | February 17, 2021 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dietitian, Registered primary | 133V00000X | 1016333 (WY) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.