Healthcare Provider Details

I. General information

NPI: 1770761074
Provider Name (Legal Business Name): SUE ANN SUTTON RN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2008
Last Update Date: 12/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2914 DOMINGO AVE
BERKELEY CA
94705-2454
US

IV. Provider business mailing address

5640 HIGHLAND AVE
RICHMOND CA
94804-5010
US

V. Phone/Fax

Practice location:
  • Phone: 510-981-0800
  • Fax:
Mailing address:
  • Phone: 510-684-6558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number12229
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: