Provider Demographics
NPI:1376260372
Name:PHELAN, SARAH HARLEY (DNP)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:HARLEY
Last Name:PHELAN
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3467 N TWEEDBROOK PL
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-1960
Mailing Address - Country:US
Mailing Address - Phone:208-318-6265
Mailing Address - Fax:
Practice Address - Street 1:2036 N COLE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-7309
Practice Address - Country:US
Practice Address - Phone:208-375-0722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID59200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily