Provider Demographics
NPI:1861744252
Name:MALLI, SARAH A (FNP-BC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:A
Last Name:MALLI
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:A
Other - Last Name:CRUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:6800 EARL AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:MT
Mailing Address - Zip Code:59037-9366
Mailing Address - Country:US
Mailing Address - Phone:406-647-3000
Mailing Address - Fax:949-577-4409
Practice Address - Street 1:6800 EARL AVE
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:MT
Practice Address - Zip Code:59037-9366
Practice Address - Country:US
Practice Address - Phone:406-647-3000
Practice Address - Fax:949-577-4409
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-RN-LIC-36449363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1861744252OtherUNKNOWN