Provider Demographics
NPI:1194163667
Name:WIERSMA, SARAH ELISABETH (MD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ELISABETH
Last Name:WIERSMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ELISABETH
Other - Last Name:WILLIAMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10200 N 92ND ST STE 150
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4535
Mailing Address - Country:US
Mailing Address - Phone:480-860-8488
Mailing Address - Fax:480-860-8498
Practice Address - Street 1:10200 N 92ND ST STE 150
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4535
Practice Address - Country:US
Practice Address - Phone:480-860-8488
Practice Address - Fax:480-860-8498
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-06
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR73950208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics