Provider Demographics
NPI:1710529961
Name:PETERS, SARAH ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ELIZABETH
Last Name:PETERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:INMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3503 SAMSON WAY STE 108
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-4303
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3503 SAMSON WAY
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-4318
Practice Address - Country:US
Practice Address - Phone:402-592-2055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2404363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant