MEDICARE: CYVADA MOLLY SUTTON NP-C

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	002732	NV
2	363LF0000X	Family Nurse Practitioner	AP10394	AZ

General Provider Information

NPI Number	:	1114409620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYVADA MOLLY SUTTON NP-C

Provider Business Mailing Address
First Line	:	PO BOX 617
Second Line	:
City	:	SOMERTON
State	:	AZ
Zip	:	85350-0617
Country	:	US
Telephone Number	:	928-315-7910
Fax Number	:	928-627-1255

Provider Business Practice Location Address
First Line	:	3320 N BUFFALO DR STE 106
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7410
Country	:	US
Telephone Number	:	702-869-6190
Fax Number	:

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

Provider Enumeration Date	:	08/30/2018
Last Update Date	:	07/28/2023

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