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General NPI Number Information
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NPI Number | 1821786393
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Entity Type | Individual
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Provider Name | DAMON SUTTLE
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Gender | Male
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Dates
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Enumeration Date | 04/24/2023
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Last Update Date | 02/20/2024
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Provider Practice Location Address
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Address Line | 6130 N LA CHOLLA BLVD STE 117
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City | TUCSON
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State | AZ
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Zip | 85741-3589
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Country | US
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Telephone | 520-742-4159
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Fax |
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Provider Business Mailing Address
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Address Line | 5055 E BROADWAY BLVD STE A100
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City | TUCSON
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State | AZ
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Zip | 85711-3629
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Country | US
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Telephone | 520-327-0460
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2023005751
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License Number State | AZ
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