Basic Information
| Provider Information | |||||||||
| NPI: | 1619637055 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARBECK | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | RDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1299 VELVETLEAF LN | ||||||||
| Address2: | |||||||||
| City: | LINO LAKES | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550389118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6127875014 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5200 FAIRVIEW BLVD | ||||||||
| Address2: | |||||||||
| City: | WYOMING | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550928013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6519827000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2021 | ||||||||
| LastUpdateDate: | 12/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | MN | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.