Healthcare Provider Details

I. General information

NPI: 1215498159
Provider Name (Legal Business Name): SARA JOSEPHINE WALTON N.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARA JO STUVER-PAHECO N.M.D.

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

839 E. WINDING CREEK DR. SUITE 202
EAGLE ID
83616
US

IV. Provider business mailing address

839 E. WINDING CREEK DR. SUITE 202
EAGLE ID
83616
US

V. Phone/Fax

Practice location:
  • Phone: 208-370-2380
  • Fax: 208-370-2381
Mailing address:
  • Phone: 208-370-2380
  • Fax: 208-370-2381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT-6095214
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNMD-0021
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: