Healthcare Provider Details

I. General information

NPI: 1760252183
Provider Name (Legal Business Name): MRS. NATASHA SUTHERLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 05/04/2024
Certification Date: 05/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 BAMMEL AVE
MEMPHIS TN
38107-1375
US

IV. Provider business mailing address

609 SANGA CIR E
CORDOVA TN
38018-7647
US

V. Phone/Fax

Practice location:
  • Phone: 901-297-8532
  • Fax:
Mailing address:
  • Phone: 901-297-8532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: