Basic Information
| Provider Information | |||||||||
| NPI: | 1194163667 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WIERSMA | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | ELISABETH | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WILLIAMSON | ||||||||
| OtherFirstName: | SARAH | ||||||||
| OtherMiddleName: | ELISABETH | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 10200 N 92ND ST STE 150 | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852584535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808608488 | ||||||||
| FaxNumber: | 4808608498 | ||||||||
| Practice Location | |||||||||
| Address1: | 10200 N 92ND ST STE 150 | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852584535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808608488 | ||||||||
| FaxNumber: | 4808608498 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2013 | ||||||||
| LastUpdateDate: | 06/15/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | R73950 | AZ | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.