Provider Demographics
NPI:1497040356
Name:DAHLSRUD, SADIE CHRISTINE (RN)
Entity Type:Individual
Prefix:
First Name:SADIE
Middle Name:CHRISTINE
Last Name:DAHLSRUD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:879 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-1840
Mailing Address - Country:US
Mailing Address - Phone:435-896-9561
Mailing Address - Fax:435-896-9564
Practice Address - Street 1:879 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701
Practice Address - Country:US
Practice Address - Phone:435-896-9561
Practice Address - Fax:435-896-9564
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7223056-4402367A00000X
UT7223056-3102163WX0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife