Healthcare Provider Details

I. General information

NPI: 1578246468
Provider Name (Legal Business Name): SADIE BAUER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1188 CALL PL
POCATELLO ID
83201-3034
US

IV. Provider business mailing address

506 W 3560 S
NIBLEY UT
84321-6999
US

V. Phone/Fax

Practice location:
  • Phone: 208-232-3216
  • Fax:
Mailing address:
  • Phone: 208-240-7742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number64371
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12373902-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: