Basic Information
| Provider Information | |||||||||
| NPI: | 1841967213 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLS | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | I | ||||||||
| Credential: | RD,LD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1702 UNIVERSITY DR S | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581034940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013648000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 900 HILLIGOSS BLVD SE | ||||||||
| Address2: | |||||||||
| City: | FOSSTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 565421542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2184351133 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2021 | ||||||||
| LastUpdateDate: | 08/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 1306 | ND | N | Dietary & Nutritional Service Providers | Dietitian, Registered | 133V00000X | 4539 | MN | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.