Basic Information
| Provider Information | |||||||||
| NPI: | 1508513748 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JEROME | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | RD, LMNT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7710 MERCY RD STE 3000 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681242350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4027171299 | ||||||||
| FaxNumber: | 4027170770 | ||||||||
| Practice Location | |||||||||
| Address1: | 7710 MERCY RD STE 3000 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681242350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4027171299 | ||||||||
| FaxNumber: | 4027170770 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2022 | ||||||||
| LastUpdateDate: | 03/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 106273 | IA | N | Dietary & Nutritional Service Providers | Dietitian, Registered | 133V00000X | 1562 | NE | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.