Provider Demographics
NPI:1437512530
Name:PETERS, SARA (CPM)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 DANCING RABBIT LN
Mailing Address - Street 2:
Mailing Address - City:RUTLEDGE
Mailing Address - State:MO
Mailing Address - Zip Code:63563-9757
Mailing Address - Country:US
Mailing Address - Phone:660-883-5594
Mailing Address - Fax:
Practice Address - Street 1:7 DANCING RABBIT LN
Practice Address - Street 2:
Practice Address - City:RUTLEDGE
Practice Address - State:MO
Practice Address - Zip Code:63563-9757
Practice Address - Country:US
Practice Address - Phone:660-883-5594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
16020007OtherNARM CPM