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General NPI Number Information
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NPI Number | 1134599210
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Entity Type | Individual
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Provider Name | SARAH ELIZABETH PEDERSEN PA
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Gender | Female
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Dates
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Enumeration Date | 10/01/2015
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Last Update Date | 04/03/2017
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Provider Practice Location Address
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Address Line | 5301 FARAON ST C
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City | SAINT JOSEPH
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State | MO
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Zip | 64506-3512
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Country | US
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Telephone | 816-437-8122
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Fax | 816-407-9609
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Provider Business Mailing Address
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Address Line | 3107 FREDERICK AVE
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City | SAINT JOSEPH
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State | MO
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Zip | 64506-2956
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Country | US
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Telephone | 816-935-9422
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Fax | 816-364-2575
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2015034091
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License Number State | MO
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