Healthcare Provider Details

I. General information

NPI: 1093017287
Provider Name (Legal Business Name): NATALIE AURELIA SUTTON RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2010
Last Update Date: 11/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

647 TUMBLEWEED RD
CHAPARRAL NM
88081-7428
US

IV. Provider business mailing address

647 TUMBLEWEED RD
CHAPARRAL NM
88081-7428
US

V. Phone/Fax

Practice location:
  • Phone: 915-449-7620
  • Fax:
Mailing address:
  • Phone: 915-449-7620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: