Healthcare Provider Details

I. General information

NPI: 1538087077
Provider Name (Legal Business Name): SHARON L BISTODEAU RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

794 WILD TURKEY RD
SANDPOINT ID
83864-9537
US

IV. Provider business mailing address

794 WILD TURKEY RD
SANDPOINT ID
83864-9537
US

V. Phone/Fax

Practice location:
  • Phone: 208-265-2437
  • Fax:
Mailing address:
  • Phone: 208-265-2437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberN-22449
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: