Provider Demographics
NPI:1861368920
Name:SANBORN, KYLE
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:SANBORN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 N PONDERA AVE APT C
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6392
Mailing Address - Country:US
Mailing Address - Phone:603-502-7851
Mailing Address - Fax:
Practice Address - Street 1:440 WINGS WAY
Practice Address - Street 2:BUILDING HANGAR 77
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714
Practice Address - Country:US
Practice Address - Phone:503-678-4364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-15
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-RN-LIC-236119163WF0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WF0300XNursing Service ProvidersRegistered NurseFlight