Provider Demographics
NPI:1609508340
Name:MARDIKIAN, SARAH ABIGAIL (PA-C)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ABIGAIL
Last Name:MARDIKIAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 SW HIGGINS AVE APT D
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-3604
Mailing Address - Country:US
Mailing Address - Phone:406-880-3486
Mailing Address - Fax:
Practice Address - Street 1:1211 SW HIGGINS AVE APT D
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803-3604
Practice Address - Country:US
Practice Address - Phone:406-880-3486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant