Provider Demographics
NPI:1932989720
Name:SADLER, NICOLE JEAN (FNP-C)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:JEAN
Last Name:SADLER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 W 300 N STE 5
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:UT
Mailing Address - Zip Code:84318-4044
Mailing Address - Country:US
Mailing Address - Phone:435-774-4113
Mailing Address - Fax:435-567-0128
Practice Address - Street 1:338 W 300 N STE 5
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:UT
Practice Address - Zip Code:84318-4044
Practice Address - Country:US
Practice Address - Phone:435-774-4113
Practice Address - Fax:435-567-0128
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-29
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9047195-3102163W00000X
UT9047195-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT4257687Medicaid
UT9047195-4405OtherSTATE LICENSE