Healthcare Provider Details

I. General information

NPI: 1801886114
Provider Name (Legal Business Name): MARY PATRICIA SUTHOFF LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1032 HILLCREST RD
MOBILE AL
36695-3917
US

IV. Provider business mailing address

1032 HILLCREST RD
MOBILE AL
36695-3917
US

V. Phone/Fax

Practice location:
  • Phone: 251-633-3311
  • Fax: 251-633-3004
Mailing address:
  • Phone: 251-633-3311
  • Fax: 251-633-3004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number2-018527
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: