MEDICARE: SABRINA M PETERSON CERT. DOULA, C.M.T,

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	374J00000X	Doula

General Provider Information

NPI Number	:	1932424215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SABRINA M PETERSON CERT. DOULA, C.M.T,

Provider Business Mailing Address
First Line	:	PO BOX 961
Second Line	:
City	:	FORT BRAGG
State	:	CA
Zip	:	95437-0961
Country	:	US
Telephone Number	:	707-272-6205
Fax Number	:

Provider Business Practice Location Address
First Line	:	346 S HARRISON ST
Second Line	:
City	:	FORT BRAGG
State	:	CA
Zip	:	95437-4904
Country	:	US
Telephone Number	:	707-272-6205
Fax Number	:

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

Provider Enumeration Date	:	03/30/2010
Last Update Date	:	03/30/2010

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