MEDICARE: MS. SARAH FAIRLIGHT CPM, LM, IBCLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175M00000X	Lay Midwife
2	367A00000X	Advanced Practice Midwife	746	CA
3	174N00000X	Lactation Consultant (Non-RN)	L-320440	CA

General Provider Information

NPI Number	:	1659847762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SARAH FAIRLIGHT CPM, LM, IBCLC

Provider Business Mailing Address
First Line	:	379 CAMINO VERDE
Second Line	:
City	:	BOULDER CREEK
State	:	CA
Zip	:	95006
Country	:	US
Telephone Number	:	801-808-3297
Fax Number	:	801-405-6260

Provider Business Practice Location Address
First Line	:	1132 21ST ST
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84401-0732
Country	:	US
Telephone Number	:	801-808-3297
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2018
Last Update Date	:	03/16/2026

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