MEDICARE: KRISTIN MARIE SUTERA BSN, RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	21445103	NY

General Provider Information

NPI Number	:	1093947178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN MARIE SUTERA BSN, RN

Provider Business Mailing Address
First Line	:	314 79TH ST
Second Line	:	APT 2D
City	:	BROOKLYN
State	:	NY
Zip	:	11209-3646
Country	:	US
Telephone Number	:	917-816-4798
Fax Number	:

Provider Business Practice Location Address
First Line	:	314 79TH ST
Second Line	:	APT 2D
City	:	BROOKLYN
State	:	NY
Zip	:	11209-3646
Country	:	US
Telephone Number	:	917-816-4798
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2009
Last Update Date	:	08/21/2009

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