Healthcare Provider Details

I. General information

NPI: 1740842905
Provider Name (Legal Business Name): MICHELLE SADLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 OVERHILL DR STE 105
MOORESVILLE NC
28117-8232
US

IV. Provider business mailing address

125 OVERHILL DR STE 105
MOORESVILLE NC
28117-8232
US

V. Phone/Fax

Practice location:
  • Phone: 704-651-5124
  • Fax: 704-799-8949
Mailing address:
  • Phone: 704-651-5124
  • Fax: 704-799-8949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201528
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5012118
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: