Healthcare Provider Details

I. General information

NPI: 1427353721
Provider Name (Legal Business Name): SARAH WAMPOLD ORR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2011
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1828 S MILLENIUM WAY STE 300
MERIDIAN ID
83642-5036
US

IV. Provider business mailing address

1828 S MILLENIUM WAY STE 300
MERIDIAN ID
83642-5036
US

V. Phone/Fax

Practice location:
  • Phone: 208-895-8775
  • Fax:
Mailing address:
  • Phone: 208-895-8775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA1024
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: