Provider Demographics
NPI:1841324621
Name:SAYRE, VIRGINIA R (RN)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:R
Last Name:SAYRE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:R
Other - Last Name:RABY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:16241 OASIS RD
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-8685
Mailing Address - Country:US
Mailing Address - Phone:208-739-0034
Mailing Address - Fax:
Practice Address - Street 1:16241 OASIS RD
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83607-8685
Practice Address - Country:US
Practice Address - Phone:208-739-0034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR098333Medicaid