Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 4704222519 | MI |
NPI | 1033279369 |
---|---|
Provider Name | Mrs. Sarah Repp Peterson |
First Address | Chelsea, MI 48118-1801 |
Second Address | Chelsea, MI 48118-1801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 09/02/2012 |