Healthcare Provider Details

I. General information

NPI: 1699989004
Provider Name (Legal Business Name): KIRSTIN MARIA PATRAGNONI-SAUTER NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIRSTIN MARIA SAUTER NURSE PRACTITIONER

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 09/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 MADISON AVENUE VIRTUA PHOENIX OB/GYN- MOUNT HOLLY- SUITE #B
PHILADELPHIA PA
19144-5497
US

IV. Provider business mailing address

1624 BROWN ST
PHILADELPHIA PA
19130-2807
US

V. Phone/Fax

Practice location:
  • Phone: 609-444-5500
  • Fax: 609-444-5506
Mailing address:
  • Phone: 856-278-3191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License NumberSP007724
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00032500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: