Provider Demographics
NPI:1801173745
Name:PERA, SANDRA COLLEEN (CPM, LM)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:COLLEEN
Last Name:PERA
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 W. OLD U.S. 2
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:49968-9216
Mailing Address - Country:US
Mailing Address - Phone:906-250-1969
Mailing Address - Fax:906-224-1383
Practice Address - Street 1:1203 W. OLD U.S. 2
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MI
Practice Address - Zip Code:49968-9216
Practice Address - Country:US
Practice Address - Phone:906-250-1969
Practice Address - Fax:906-224-1383
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI38-049176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife