Healthcare Provider Details

I. General information

NPI: 1154284404
Provider Name (Legal Business Name): MICHELLE LEE SUTTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14078 COUNTY ROAD G62
WAPELLO IA
52653-9277
US

IV. Provider business mailing address

14078 COUNTY ROAD G62
WAPELLO IA
52653-9277
US

V. Phone/Fax

Practice location:
  • Phone: 563-299-1920
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number163994
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: