Provider Demographics
NPI:1396158192
Name:PETERS, SALLIE (PA)
Entity type:Individual
Prefix:
First Name:SALLIE
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:500 W 144TH AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80023-9326
Mailing Address - Country:US
Mailing Address - Phone:720-627-4980
Mailing Address - Fax:720-627-4981
Practice Address - Street 1:500 W 144TH AVE STE 230
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80023-9328
Practice Address - Country:US
Practice Address - Phone:303-665-2603
Practice Address - Fax:303-665-2605
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical