Provider Demographics
NPI:1245108869
Name:DEL RAE, SARAH DOROTHY
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:DOROTHY
Last Name:DEL RAE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 N DUCK HAWK AVE
Mailing Address - Street 2:
Mailing Address - City:KUNA
Mailing Address - State:ID
Mailing Address - Zip Code:83634-3412
Mailing Address - Country:US
Mailing Address - Phone:406-531-7888
Mailing Address - Fax:
Practice Address - Street 1:3271 N MILWAUKEE ST STE 201
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-4425
Practice Address - Country:US
Practice Address - Phone:208-375-1072
Practice Address - Fax:208-375-1673
Is Sole Proprietor?:No
Enumeration Date:2025-10-27
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID5371387363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily