Healthcare Provider Details

I. General information

NPI: 1114001732
Provider Name (Legal Business Name): COREY SUTTER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 01/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019 GALISTEO ST STE J-1
SANTA FE NM
87505-2143
US

IV. Provider business mailing address

2019 GALISTEO ST STE J-1
SANTA FE NM
87505-2143
US

V. Phone/Fax

Practice location:
  • Phone: 505-820-0446
  • Fax:
Mailing address:
  • Phone: 505-820-0446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR29804
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: