Provider Demographics
NPI:1306125224
Name:SANGER HEART AND VASCULAR INSTITUTE
Entity type:Organization
Organization Name:SANGER HEART AND VASCULAR INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADULT NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:SAEDRA
Authorized Official - Middle Name:E
Authorized Official - Last Name:PATELLA
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:704-373-0212
Mailing Address - Street 1:1001 BLYTHE BOULEVARD, CHARLOTTE
Mailing Address - Street 2:# 300
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203
Mailing Address - Country:US
Mailing Address - Phone:919-306-5992
Mailing Address - Fax:
Practice Address - Street 1:1001 BLYTHE BLVD
Practice Address - Street 2:# 300
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5866
Practice Address - Country:US
Practice Address - Phone:704-373-0212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-09
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005274363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty