Healthcare Provider Details

I. General information

NPI: 1376260372
Provider Name (Legal Business Name): SARAH HARLEY PHELAN DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2022
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2036 N COLE RD
BOISE ID
83704-7309
US

IV. Provider business mailing address

3467 N TWEEDBROOK PL
BOISE ID
83713-1960
US

V. Phone/Fax

Practice location:
  • Phone: 208-375-0722
  • Fax:
Mailing address:
  • Phone: 208-318-6265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number59200
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: