Provider Demographics
NPI:1104429695
Name:SUTTER, ALBERT CHARLES
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:CHARLES
Last Name:SUTTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 GRANGER RD UNIT 88
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-7363
Mailing Address - Country:US
Mailing Address - Phone:330-715-3116
Mailing Address - Fax:
Practice Address - Street 1:249 GRANGER RD UNIT 88
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-7363
Practice Address - Country:US
Practice Address - Phone:330-715-3116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide