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General NPI Number Information
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NPI Number | 1700236593
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Entity Type | Individual
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Provider Name | MARY LAUREN SABATINO PNP
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Gender | Female
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Dates
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Enumeration Date | 06/13/2016
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Last Update Date | 01/31/2018
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Provider Practice Location Address
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Address Line | 111 IVY DR APT 2
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22903-5012
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Country | US
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Telephone | 610-220-7148
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Fax |
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Provider Business Mailing Address
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Address Line | 111 IVY DRIVE APT 2
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22903
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Country | US
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Telephone | 610-220-7148
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 0024174591
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 701859-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 0001267841
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License Number State | VA
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