Provider Demographics
NPI:1457456212
Name:KOOIENGA, SARAH (FNP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:KOOIENGA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 EAST 17TH STREET
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-4797
Mailing Address - Country:US
Mailing Address - Phone:307-632-2434
Mailing Address - Fax:307-634-7691
Practice Address - Street 1:1252 N 22ND ST, UNIT A
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-5306
Practice Address - Country:US
Practice Address - Phone:307-745-5364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY34298.1347363LF0000X
OR092006866N1 FNP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily