Provider Demographics
NPI:1790359800
Name:PETERSON, SARAH ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ELIZABETH
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5580 NORDIC WAY
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-5104
Mailing Address - Country:US
Mailing Address - Phone:360-384-1511
Mailing Address - Fax:360-384-5758
Practice Address - Street 1:5580 NORDIC WAY
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-5104
Practice Address - Country:US
Practice Address - Phone:360-384-1511
Practice Address - Fax:360-384-5758
Is Sole Proprietor?:No
Enumeration Date:2021-05-14
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61435590207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine