Healthcare Provider Details

I. General information

NPI: 1538668637
Provider Name (Legal Business Name): ANNETTE SUTTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 W RIVER RD N
ELYRIA OH
44035-2791
US

IV. Provider business mailing address

1530 W RIVER RD N
ELYRIA OH
44035-2791
US

V. Phone/Fax

Practice location:
  • Phone: 440-953-9999
  • Fax:
Mailing address:
  • Phone: 440-322-9158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.0031095
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: