Healthcare Provider Details

I. General information

NPI: 1760853162
Provider Name (Legal Business Name): MARGO DIANE SUTTON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2015
Last Update Date: 10/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 PATTERSON ROAD
RIVERBANK CA
95367
US

IV. Provider business mailing address

737 W CHILDS AVE
MERCED CA
95341-6805
US

V. Phone/Fax

Practice location:
  • Phone: 209-863-3990
  • Fax: 209-863-3999
Mailing address:
  • Phone: 209-385-5529
  • Fax: 209-383-1296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95003193
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: