Doctor Name: | VICKIE SUTTON |
NPI Number: | 1053714097 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 577639 |
Business Practice Address: | 29439 Canyon Valley Dr Lake Elsinore, CA - 925307282 |
Business Phone Number: | 9515053977 |
Business Fax Number: | |
Mailing Address: | 29439 Canyon Valley Dr, LAKE ELSINORE |
State: | CA |
Postal Code: | 925307282 |
Phone Number: | 9515053977 |
Fax Number: | |
NPI Enumeration Date: | 10/05/2014 |
NPI Last Update Date: | 10/05/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 163WH0200X |
License Number: | 577639 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Registered Nurse |
Taxonomy Specialization: | Home Health |
Taxonomy Definition: |