Provider Demographics
NPI:1447747282
Name:CZARNECKI, SARAH ANN (RD, LD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ANN
Last Name:CZARNECKI
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:752 CLAYVIS CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-6328
Mailing Address - Country:US
Mailing Address - Phone:859-351-9989
Mailing Address - Fax:
Practice Address - Street 1:752 CLAYVIS CT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-6328
Practice Address - Country:US
Practice Address - Phone:859-351-9989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY86090121133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty