Healthcare Provider Details

I. General information

NPI: 1235290743
Provider Name (Legal Business Name): DEBBORA SUTHERLAND GNP, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 04/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 BOND ST. SPOPC
SPRINGFIELD MA
01104
US

IV. Provider business mailing address

25 BOND STREET DVA SPOPC MHICM
SPRINGFIELD MA
01104
US

V. Phone/Fax

Practice location:
  • Phone: 413-731-6000
  • Fax: 413-788-4617
Mailing address:
  • Phone: 413-731-6000
  • Fax: 413-788-4617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number000698
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: