Provider Demographics
NPI:1861630832
Name:LEEPER, SARAH RUTH (APRN)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:RUTH
Last Name:LEEPER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 E MAIN ST STE E
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2289
Mailing Address - Country:US
Mailing Address - Phone:801-766-9822
Mailing Address - Fax:801-766-9441
Practice Address - Street 1:127 E MAIN ST STE E
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2289
Practice Address - Country:US
Practice Address - Phone:801-766-9822
Practice Address - Fax:801-766-9441
Is Sole Proprietor?:No
Enumeration Date:2009-01-29
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7152399-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1861630832Medicaid
UTU000076014Medicare PIN