Provider Demographics
NPI:1942608161
Name:KANE, SADIE PATRICIA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:SADIE
Middle Name:PATRICIA
Last Name:KANE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7011 LINDA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-6307
Mailing Address - Country:US
Mailing Address - Phone:858-810-8787
Mailing Address - Fax:858-987-5825
Practice Address - Street 1:7011 LINDA VISTA RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-6307
Practice Address - Country:US
Practice Address - Phone:858-810-8787
Practice Address - Fax:858-987-5825
Is Sole Proprietor?:No
Enumeration Date:2014-12-22
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-03073363LP0808X
CA95004685363LP0808X
CA846300163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse