Healthcare Provider Details

I. General information

NPI: 1104471309
Provider Name (Legal Business Name): STEPHANIE NORTHERN SADTLER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6627 WEST BROAD STREET SUITE 400
RICHMOND VA
23230
US

IV. Provider business mailing address

6627 WEST BROAD STREET SUITE 400
RICHMOND VA
23230
US

V. Phone/Fax

Practice location:
  • Phone: 804-774-4550
  • Fax:
Mailing address:
  • Phone: 804-330-4021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001225659
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number00241718191
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: