Healthcare Provider Details

I. General information

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

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

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5513 N GLENWOOD ST SUITE C
GARDEN CITY ID
83714
US

IV. Provider business mailing address

5513 N GLENWOOD ST SUITE C
GARDEN CITY ID
83714
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: