Provider Demographics
NPI:1518414200
Name:FAIRHURST, SARAH (NP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:FAIRHURST
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24680 JEFFERSON AVE
Mailing Address - Street 2:#A
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-9023
Mailing Address - Country:US
Mailing Address - Phone:951-677-2252
Mailing Address - Fax:951-677-3838
Practice Address - Street 1:24680 JEFFERSON AVE
Practice Address - Street 2:#A
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-9023
Practice Address - Country:US
Practice Address - Phone:951-677-2252
Practice Address - Fax:951-677-3838
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004942363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95004942OtherSTATE