Provider Demographics
NPI:1043503113
Name:PFENNIG, PAUL (ACNS-BC, FNP-BC, ANP)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:PFENNIG
Suffix:
Gender:M
Credentials:ACNS-BC, FNP-BC, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:MT
Mailing Address - Zip Code:59270-4127
Mailing Address - Country:US
Mailing Address - Phone:406-488-5000
Mailing Address - Fax:
Practice Address - Street 1:309 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:MT
Practice Address - Zip Code:59270-4127
Practice Address - Country:US
Practice Address - Phone:406-488-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR28464363LA2200X, 364SA2200X, 363LF0000X
TX1671363LA2200X
MTNUR-RN-LIC-77188363LA2200X, 364SA2200X
OH020144363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health