Healthcare Provider Details

I. General information

NPI: 1477956357
Provider Name (Legal Business Name): SARAH LISA PETERSON APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2014
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 CENTER ST
MOBILE AL
36604-1541
US

IV. Provider business mailing address

PO BOX 746750
ATLANTA GA
30374-6750
US

V. Phone/Fax

Practice location:
  • Phone: 251-415-1496
  • Fax: 251-415-1450
Mailing address:
  • Phone: 866-401-3057
  • Fax: 318-868-6430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3-001999
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209-011921
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3-001999
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: