Provider Demographics
NPI:1386740785
Name:HENNEMANN, SARAH JANE (MD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:JANE
Last Name:HENNEMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:SARAH
Other - Middle Name:JANE
Other - Last Name:KALT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3066 E MERIDIAN PARK LOOP
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7299
Mailing Address - Country:US
Mailing Address - Phone:907-357-9590
Mailing Address - Fax:
Practice Address - Street 1:3066 E MERIDIAN PARK LOOP
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7299
Practice Address - Country:US
Practice Address - Phone:907-357-9590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI49139-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD8536Medicaid