Provider Demographics
NPI:1427241389
Name:LONGOBARDI, SARA R (PA-C)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:R
Last Name:LONGOBARDI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 ROGERS WAY
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-2660
Mailing Address - Country:US
Mailing Address - Phone:763-248-8854
Mailing Address - Fax:
Practice Address - Street 1:830 ROGERS WAY
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-2660
Practice Address - Country:US
Practice Address - Phone:763-248-8854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10304363AM0700X
MTMED-PAC-LIC-51845363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical