Healthcare Provider Details

I. General information

NPI: 1124679683
Provider Name (Legal Business Name): BENESSA MITCHELL SUTTON AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2019
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 STANTONSBURG RD
GREENVILLE NC
27834-2818
US

IV. Provider business mailing address

2100 STANTONSBURG RD
GREENVILLE NC
27834-2818
US

V. Phone/Fax

Practice location:
  • Phone: 252-847-4100
  • Fax:
Mailing address:
  • Phone: 252-847-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5012331
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: