Provider Demographics
NPI:1225834237
Name:CARLSEN, SADIE NICOLE (NP-C)
Entity type:Individual
Prefix:
First Name:SADIE
Middle Name:NICOLE
Last Name:CARLSEN
Suffix:
Gender:
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 E PINE AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-2321
Mailing Address - Country:US
Mailing Address - Phone:208-871-5303
Mailing Address - Fax:
Practice Address - Street 1:211 E PINE AVE STE 105
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2321
Practice Address - Country:US
Practice Address - Phone:208-713-7690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID3971243363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily