Provider Demographics
NPI:1114912227
Name:SAKAUTZKI, KATHY M (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:M
Last Name:SAKAUTZKI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14425 BUSTLETON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-1177
Mailing Address - Country:US
Mailing Address - Phone:215-464-9599
Mailing Address - Fax:215-464-7865
Practice Address - Street 1:14425 BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-1177
Practice Address - Country:US
Practice Address - Phone:215-464-9599
Practice Address - Fax:215-464-7865
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP005116C363LA2200X
PASP005454B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA021131JLTMedicare ID - Type Unspecified