Healthcare Provider Details

I. General information

NPI: 1902736036
Provider Name (Legal Business Name): SHARI CLOWE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12271 N NINEBARK RD
HAUSER ID
83854-6999
US

IV. Provider business mailing address

12271 N NINEBARK RD
HAUSER ID
83854-6999
US

V. Phone/Fax

Practice location:
  • Phone: 208-659-3087
  • Fax:
Mailing address:
  • Phone: 208-659-3087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number39435
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: