Basic Information
| Provider Information | |||||||||
| NPI: | 1114912227 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAKAUTZKI | ||||||||
| FirstName: | KATHY | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | C.R.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14425 BUSTLETON AVE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191161177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154649599 | ||||||||
| FaxNumber: | 2154647865 | ||||||||
| Practice Location | |||||||||
| Address1: | 14425 BUSTLETON AVE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191161177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154649599 | ||||||||
| FaxNumber: | 2154647865 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | SP005116C | PA | X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LF0000X | SP005454B | PA | X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.