Provider Demographics
NPI:1164197109
Name:PETERNELL, SARA (MNT, BCHN)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:PETERNELL
Suffix:
Gender:F
Credentials:MNT, BCHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3060 NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-3644
Mailing Address - Country:US
Mailing Address - Phone:720-810-7027
Mailing Address - Fax:
Practice Address - Street 1:6650 W 44TH AVE
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4750
Practice Address - Country:US
Practice Address - Phone:720-810-7027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist