Provider Demographics
NPI:1568284115
Name:PETERSON, SARAH DIANE ANDERSON (LVN)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:DIANE ANDERSON
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 CONSTITUTION BLVD
Mailing Address - Street 2:BLDG 400, SUITE 202
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906
Mailing Address - Country:US
Mailing Address - Phone:831-796-1700
Mailing Address - Fax:
Practice Address - Street 1:1441 CONSTITUTION BLVD STE 202
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3127
Practice Address - Country:US
Practice Address - Phone:831-796-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA697265164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse