MEDICARE: CHRISTIANAH SUTTON FNP - C

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	363LF0000X	Family Nurse Practitioner	834083	NV

General Provider Information

NPI Number	:	1356938716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIANAH SUTTON FNP - C

Provider Business Mailing Address
First Line	:	4903 VEGAS DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-2367
Country	:	US
Telephone Number	:	702-998-1200
Fax Number	:

Provider Business Practice Location Address
First Line	:	4903 VEGAS DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-2367
Country	:	US
Telephone Number	:	702-998-1200
Fax Number	:

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

Provider Enumeration Date	:	12/30/2020
Last Update Date	:	12/30/2020

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