Provider Demographics
NPI:1811041148
Name:SACHSEL, NANCY L (PA-C)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:SACHSEL
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 1:200 OCEANGATE
Mailing Address - Street 2:SUIT 100
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4317
Mailing Address - Country:US
Mailing Address - Phone:505-200-3320
Mailing Address - Fax:877-860-2279
Practice Address - Street 1:7317 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-2015
Practice Address - Country:US
Practice Address - Phone:505-200-3320
Practice Address - Fax:877-860-2279
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO63363A00000X, 363AM0700X
NMPA2011-0055363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM19975554Medicaid
NMP01448519/DV3487OtherRAILROAD MEDICARE- EFF 1/1/14
P41492Medicare UPIN
NM19975554Medicaid
C805059Medicare PIN