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General NPI Number Information
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NPI Number | 1861368920
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Entity Type | Individual
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Provider Name | KYLE SANBORN
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Gender | Male
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Dates
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Enumeration Date | 10/15/2025
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 440 WINGS WAY BUILDING HANGAR 77
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City | BELGRADE
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State | MT
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Zip | 59714
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Country | US
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Telephone | 503-678-4364
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Fax |
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Provider Business Mailing Address
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Address Line | 205 N PONDERA AVE APT C
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City | BOZEMAN
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State | MT
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Zip | 59718-6392
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Country | US
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Telephone | 603-502-7851
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WF0300X
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Taxonomy Name | Flight Registered Nurse
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License Number | NUR-RN-LIC-236119
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License Number State | MT
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