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General NPI Number Information
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NPI Number | 1407327737
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Entity Type | Individual
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Provider Name | CAROLINE SUTTLE PHYSICIAN ASSISTANT
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Gender | Female
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Dates
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Enumeration Date | 12/16/2018
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Last Update Date | 04/26/2019
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Provider Practice Location Address
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Address Line | 44 BARCLAY RD
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-1465
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Country | US
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Telephone | 757-236-3945
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Fax |
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Provider Business Mailing Address
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Address Line | 185 E 85TH ST APT 11A
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City | NEW YORK
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State | NY
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Zip | 10028-2165
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 023243
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License Number State | NY
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