Provider Demographics
NPI:1538155502
Name:MABARY, SARAH FAYE (RD LD)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:FAYE
Last Name:MABARY
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 1:1584 420TH ST
Mailing Address - Street 2:
Mailing Address - City:EMERSON
Mailing Address - State:IA
Mailing Address - Zip Code:51533-6029
Mailing Address - Country:US
Mailing Address - Phone:712-824-7570
Mailing Address - Fax:
Practice Address - Street 1:1584 420TH ST
Practice Address - Street 2:
Practice Address - City:EMERSON
Practice Address - State:IA
Practice Address - Zip Code:51533-6029
Practice Address - Country:US
Practice Address - Phone:712-824-7570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00601133V00000X
IA805482133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1538155502Medicare PIN