Provider Demographics
NPI:1275877912
Name:ZEHNPFENNIG, SARA MARIE (ANP-BC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:MARIE
Last Name:ZEHNPFENNIG
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:MARIE
Other - Last Name:MOMOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP-BC
Mailing Address - Street 1:2901 BROOKS ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-7722
Mailing Address - Country:US
Mailing Address - Phone:406-541-8466
Mailing Address - Fax:
Practice Address - Street 1:2901 BROOKS ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-7722
Practice Address - Country:US
Practice Address - Phone:406-541-8466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704263797363LA2200X
MTNUR-RN-LIC-46519363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTM011003116Medicare PIN