MEDICARE: ANGELA DECARLA SALE FNP-BC

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	363LF0000X	Family Nurse Practitioner	5010301	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	P00737275	OTHER	IN	RAILROAD INDIVIDUAL
3	71002719A	OTHER	IN	NP LICENSURE
4	CA6833	OTHER	IN	RAILROAD GROUP

General Provider Information

NPI Number	:	1477702728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA DECARLA SALE FNP-BC

Provider Business Mailing Address
First Line	:	4100 CARMEL RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-6150
Country	:	US
Telephone Number	:	704-542-9210
Fax Number	:

Provider Business Practice Location Address
First Line	:	4100 CARMEL RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-6150
Country	:	US
Telephone Number	:	704-542-9210
Fax Number	:

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

Provider Enumeration Date	:	09/11/2008
Last Update Date	:	02/28/2018

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