Provider Demographics
NPI:1740842905
Name:SADLER, MICHELLE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:SADLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 OVERHILL DR STE 105
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8232
Mailing Address - Country:US
Mailing Address - Phone:704-651-5124
Mailing Address - Fax:704-799-8949
Practice Address - Street 1:125 OVERHILL DR STE 105
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8232
Practice Address - Country:US
Practice Address - Phone:704-651-5124
Practice Address - Fax:704-799-8949
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201528163W00000X
NC5012118363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC201528OtherRN LICENSE NUMBER 201528
NC5012118OtherPMHNP LICENSE NUMBER 5012118