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NPI Code Detail

MEDICARE: MRS. NICHOLE CARMELLA SUTHERLAND CNP, APRN

MEDICARE: MRS. NICHOLE CARMELLA SUTHERLAND CNP, APRN
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
1363L00000XNurse PractitionerAPRN.CNP.0041096OH

General Provider Information

NPI Number : 1457217739
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. NICHOLE CARMELLA SUTHERLAND CNP, APRN
Provider Business Mailing Address
First Line : 1451 COUNTY ROAD 302
Second Line :
City : BELLEVUE
State : OH
Zip : 44811-9024
Country : US
Telephone Number : 419-618-6454
Fax Number :
Provider Business Practice Location Address
First Line : 1401 BONE CREEK DR
Second Line :
City : SANDUSKY
State : OH
Zip : 44870-7267
Country : US
Telephone Number : 419-625-4900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2025
Last Update Date : 12/30/2025

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