Provider Demographics
NPI:1073294559
Name:PETELINSEK, SARAH SUZANNE
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:SUZANNE
Last Name:PETELINSEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 E 2100 S APT 434
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-6802
Mailing Address - Country:US
Mailing Address - Phone:262-490-6328
Mailing Address - Fax:
Practice Address - Street 1:1155 E 2100 S APT 434
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-6802
Practice Address - Country:US
Practice Address - Phone:262-490-6328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program