Provider Demographics
NPI:1194063099
Name:SUTTON, SANDY (RN)
Entity type:Individual
Prefix:MRS
First Name:SANDY
Middle Name:
Last Name:SUTTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 N PAGE ST
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:SC
Mailing Address - Zip Code:29709-1201
Mailing Address - Country:US
Mailing Address - Phone:843-623-2206
Mailing Address - Fax:843-623-2469
Practice Address - Street 1:203 NORTH PAGE STREET
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:SC
Practice Address - Zip Code:29709
Practice Address - Country:US
Practice Address - Phone:843-623-2206
Practice Address - Fax:843-623-2469
Is Sole Proprietor?:No
Enumeration Date:2013-01-28
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43905163WH0200X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WS0200XNursing Service ProvidersRegistered NurseSchool