Provider Demographics
NPI:1437817103
Name:TYLER-PETERSON, SARAH JANE (CNM)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JANE
Last Name:TYLER-PETERSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2448 CTY RD DD
Mailing Address - Street 2:
Mailing Address - City:WOODVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54028
Mailing Address - Country:US
Mailing Address - Phone:715-928-0069
Mailing Address - Fax:
Practice Address - Street 1:1100 BERGSLIEN ST
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:WI
Practice Address - Zip Code:54002-2600
Practice Address - Country:US
Practice Address - Phone:715-684-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-30
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI149027367A00000X
WI149027-32176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife