Provider Demographics
NPI:1679812309
Name:ENGBERG, SARA MAE (RD, LN)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:MAE
Last Name:ENGBERG
Suffix:
Gender:F
Credentials:RD, LN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1541 CORNERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-8611
Mailing Address - Country:US
Mailing Address - Phone:406-329-2602
Mailing Address - Fax:406-327-3331
Practice Address - Street 1:900 N ORANGE ST STE 303
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-2956
Practice Address - Country:US
Practice Address - Phone:406-329-2602
Practice Address - Fax:406-327-3331
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT963112133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered