Healthcare Provider Details

I. General information

NPI: 1063419695
Provider Name (Legal Business Name): GRETCHEN L SUTTON P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GRETCHEN L PHELPS

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 US HIGHWAY 45 N
ELDORADO IL
62930-3765
US

IV. Provider business mailing address

272 COUNTRY RD 300 N
NORRIS CITY IL
62869
US

V. Phone/Fax

Practice location:
  • Phone: 618-297-9660
  • Fax:
Mailing address:
  • Phone: 618-599-2663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085001662
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: