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NPI Code Detail

MEDICARE: STACY SUTTON MSW

MEDICARE: STACY SUTTON MSW
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
1104100000XSocial Worker5893-SNV

General Provider Information

NPI Number : 1720383367
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACY SUTTON MSW
Provider Business Mailing Address
First Line : 2803 MORA CT
Second Line :
City : HENDERSON
State : NV
Zip : 89074-2485
Country : US
Telephone Number : 971-506-3724
Fax Number :
Provider Business Practice Location Address
First Line : 3170 E SUNSET RD STE A
Second Line :
City : LAS VEGAS
State : NV
Zip : 89120-2755
Country : US
Telephone Number : 702-629-6001
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2011
Last Update Date : 01/12/2011

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