Provider Demographics
NPI:1689268260
Name:PETERSON, SARAH GEORGINE (DNP,ARNP,FNP-C)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:GEORGINE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:DNP,ARNP,FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 E GREENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:OR
Mailing Address - Zip Code:97828-1633
Mailing Address - Country:US
Mailing Address - Phone:541-263-1225
Mailing Address - Fax:
Practice Address - Street 1:107 NORTH RIVER STREET
Practice Address - Street 2:SUITE B
Practice Address - City:ENTERPRISE
Practice Address - State:OR
Practice Address - Zip Code:97828-1633
Practice Address - Country:US
Practice Address - Phone:541-263-1225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-24
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202201745NP-PP363LF0000X, 363LP2300X
OR202101745NP-PP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORUNKNOWNOtherWALLOWA MEMORIAL HOSPITAL
ORF01211016OtherAANP
OR202101745NP-PPOtherAANP