Provider Demographics
NPI:1215122650
Name:SUTTON, MARK SR (LPN)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SUTTON
Suffix:SR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 VILLAGE RD
Mailing Address - Street 2:APT. 3
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-7400
Mailing Address - Country:US
Mailing Address - Phone:443-536-9391
Mailing Address - Fax:
Practice Address - Street 1:3300 N RIDGE RD
Practice Address - Street 2:SUITE 175
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-3383
Practice Address - Country:US
Practice Address - Phone:410-750-3474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP43095164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse