Provider Demographics
NPI:1346768330
Name:HALL, SARAH MARIE
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:MARIE
Last Name:HALL
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 1:175 RIVERVIEW ST
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-4837
Mailing Address - Country:US
Mailing Address - Phone:702-508-1615
Mailing Address - Fax:208-888-0884
Practice Address - Street 1:2321 E GALA ST STE 3
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-7692
Practice Address - Country:US
Practice Address - Phone:208-888-5848
Practice Address - Fax:208-888-0884
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9494778363LF0000X
IDCNP61367363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9494778OtherARNP
IDCNP61367OtherIDAHO STATE BOARD OF NURSING