Healthcare Provider Details

I. General information

NPI: 1548316573
Provider Name (Legal Business Name): MARSHA L. SUTTON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4602 MACCORKLE AVENUE SE
CHARLESTON WV
25304
US

IV. Provider business mailing address

3200 MACCORKLE AVE SE
CHARLESTON WV
25304-1227
US

V. Phone/Fax

Practice location:
  • Phone: 304-925-4777
  • Fax: 304-388-4870
Mailing address:
  • Phone: 304-388-7784
  • Fax: 304-388-7788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number32405
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number32405
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: