Provider Demographics
NPI:1457695405
Name:PETEE, SARA C (FNP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:C
Last Name:PETEE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:STONER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:140 COLEMANS XING STE 110
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-7195
Mailing Address - Country:US
Mailing Address - Phone:937-578-7950
Mailing Address - Fax:937-578-7955
Practice Address - Street 1:140 COLEMANS XING STE 110
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-7195
Practice Address - Country:US
Practice Address - Phone:937-578-7950
Practice Address - Fax:937-578-7955
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.13999363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0077092Medicaid