Provider Demographics
NPI:1215498159
Name:WALTON, SARA JOSEPHINE (NMD)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:JOSEPHINE
Last Name:WALTON
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:SARA JO
Other - Middle Name:
Other - Last Name:STUVER-PAHECO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NMD
Mailing Address - Street 1:839 E. WINDING CREEK DR.
Mailing Address - Street 2:SUITE 202
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616
Mailing Address - Country:US
Mailing Address - Phone:208-370-2380
Mailing Address - Fax:208-370-2381
Practice Address - Street 1:839 E. WINDING CREEK DR.
Practice Address - Street 2:SUITE 202
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616
Practice Address - Country:US
Practice Address - Phone:208-370-2380
Practice Address - Fax:208-370-2381
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT-6095214175F00000X
175F00000X
IDNMD-0021175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath