Provider Demographics
NPI:1588191217
Name:SADLER, NICOLE ANNMARIE
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANNMARIE
Last Name:SADLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ANNMARIE
Other - Last Name:SADLER WRIGHT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:20918 116TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-1157
Mailing Address - Country:US
Mailing Address - Phone:347-733-0643
Mailing Address - Fax:
Practice Address - Street 1:20918 116TH AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11411-1157
Practice Address - Country:US
Practice Address - Phone:347-733-0643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY677876163W00000X
NY342962363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse