Healthcare Provider Details

I. General information

NPI: 1205672086
Provider Name (Legal Business Name): CALEY SUTTLE LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 10/10/2024
Certification Date: 07/02/2024
Deactivation Date: 07/02/2024
Reactivation Date: 10/10/2024

III. Provider practice location address

425 JULIANA ST
PARKERSBURG WV
26101-5352
US

IV. Provider business mailing address

1319 BLENNERHASSETT AVE UNIT B
BELPRE OH
45714-2272
US

V. Phone/Fax

Practice location:
  • Phone: 304-893-9777
  • Fax:
Mailing address:
  • Phone: 304-580-9411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number38191
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: