Provider Demographics
NPI:1053565671
Name:WILFONG, SARA STOVER (RD)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:STOVER
Last Name:WILFONG
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:SARA
Other - Middle Name:KATELYN
Other - Last Name:STOVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:PO BOX 1430
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22803-1430
Mailing Address - Country:US
Mailing Address - Phone:540-564-5636
Mailing Address - Fax:540-433-4123
Practice Address - Street 1:2006 HEALTH CAMPUS DR
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-8679
Practice Address - Country:US
Practice Address - Phone:540-689-5800
Practice Address - Fax:540-689-5801
Is Sole Proprietor?:No
Enumeration Date:2008-11-10
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1417027608OtherRMH GROUP NPI
VAC05754OtherRMH MEDICARE GROUP PTAN