Provider Demographics
NPI:1154393528
Name:SUTHERLAND, VERONICA M (DO)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:M
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5975 S LOS ALTOS PKWY
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-7699
Mailing Address - Country:US
Mailing Address - Phone:775-204-4000
Mailing Address - Fax:775-204-4001
Practice Address - Street 1:6630 S MCCARRAN BLVD STE 9
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6145
Practice Address - Country:US
Practice Address - Phone:775-204-4000
Practice Address - Fax:775-402-4001
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3788207Q00000X, 207VX0000X
NVDO1503207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ717605Medicaid
AZ717605Medicaid