Provider Demographics
NPI:1699989004
Name:PATRAGNONI-SAUTER, KIRSTIN MARIA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:MARIA
Last Name:PATRAGNONI-SAUTER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:KIRSTIN
Other - Middle Name:MARIA
Other - Last Name:SAUTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:1624 BROWN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-2807
Mailing Address - Country:US
Mailing Address - Phone:856-278-3191
Mailing Address - Fax:
Practice Address - Street 1:120 MADISON AVENUE
Practice Address - Street 2:VIRTUA PHOENIX OB/GYN- MOUNT HOLLY- SUITE #B
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-5497
Practice Address - Country:US
Practice Address - Phone:609-444-5500
Practice Address - Fax:609-444-5506
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007724163WC1400X
NJ26NJ00032500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC1400XNursing Service ProvidersRegistered NurseCollege Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ345402YBAWMedicare UPIN