Basic Information
| Provider Information | |||||||||
| NPI: | 1518187012 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAGARSEE | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | BETH | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | R.D., C.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2087 S CO RD 275 E | ||||||||
| Address2: | |||||||||
| City: | SULLIVAN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 47882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122686617 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2200 N SECTION ST | ||||||||
| Address2: | |||||||||
| City: | SULLIVAN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478827523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122684311 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 864206 | IN | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.