Provider Demographics
NPI:1174828081
Name:PETERSEN, SARAH AMY (LM)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:AMY
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1743 S RED ROCK ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-4985
Mailing Address - Country:US
Mailing Address - Phone:480-316-9144
Mailing Address - Fax:480-336-2576
Practice Address - Street 1:1743 S RED ROCK ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-4985
Practice Address - Country:US
Practice Address - Phone:480-316-9144
Practice Address - Fax:480-336-2576
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ132176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife