Provider Demographics
NPI:1174850747
Name:HEINEMAN, SARA (APRN FNP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:HEINEMAN
Suffix:
Gender:F
Credentials:APRN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W ALDER ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4123
Mailing Address - Country:US
Mailing Address - Phone:406-258-4987
Mailing Address - Fax:406-258-4913
Practice Address - Street 1:301 W ALDER ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4123
Practice Address - Country:US
Practice Address - Phone:406-258-4987
Practice Address - Fax:406-258-4913
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN29351363LF0000X
WAAP60120444363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily