MEDICARE: MRS. KATHY M SAKAUTZKI C.R.N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	SP005116C	PA
2	363LF0000X	Family Nurse Practitioner	SP005454B	PA

General Provider Information

NPI Number	:	1114912227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHY M SAKAUTZKI C.R.N.P.

Provider Business Mailing Address
First Line	:	14425 BUSTLETON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19116-1177
Country	:	US
Telephone Number	:	215-464-9599
Fax Number	:	215-464-7865

Provider Business Practice Location Address
First Line	:	14425 BUSTLETON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19116-1177
Country	:	US
Telephone Number	:	215-464-9599
Fax Number	:	215-464-7865

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	09/11/2025

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