Healthcare Provider Details

I. General information

NPI: 1043503113
Provider Name (Legal Business Name): PAUL PFENNIG ACNS-BC, FNP-BC, ANP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 08/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 S CENTRAL AVE
SIDNEY MT
59270-4127
US

IV. Provider business mailing address

309 S CENTRAL AVE
SIDNEY MT
59270-4127
US

V. Phone/Fax

Practice location:
  • Phone: 406-488-5000
  • Fax:
Mailing address:
  • Phone: 406-488-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR28464
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1671
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNUR-RN-LIC-77188
License Number StateMT
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number020144
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberR28464
License Number StateND
# 6
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberNUR-RN-LIC-77188
License Number StateMT
# 7
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR28464
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: