Provider Demographics
NPI:1053198259
Name:TEE, SARAH M (MPH RD LRD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:M
Last Name:TEE
Suffix:
Gender:F
Credentials:MPH RD LRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4758 11TH ST W
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-8397
Mailing Address - Country:US
Mailing Address - Phone:630-439-4775
Mailing Address - Fax:
Practice Address - Street 1:1630 1ST AVE N STE B
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-4246
Practice Address - Country:US
Practice Address - Phone:630-439-4775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.006411133V00000X
ND1117133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered