Provider Demographics
NPI:1619592912
Name:HULL, SARA MARIE (NP-C)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:MARIE
Last Name:HULL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:MARIE
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:93 QUIET PL
Mailing Address - Street 2:
Mailing Address - City:MOYIE SPRINGS
Mailing Address - State:ID
Mailing Address - Zip Code:83845-5357
Mailing Address - Country:US
Mailing Address - Phone:208-290-5354
Mailing Address - Fax:
Practice Address - Street 1:6641 KANIKSU ST
Practice Address - Street 2:
Practice Address - City:BONNERS FERRY
Practice Address - State:ID
Practice Address - Zip Code:83805-7532
Practice Address - Country:US
Practice Address - Phone:208-267-3655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID65050363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily