Provider Demographics
NPI:1215984554
Name:SUTTER, CAROLYN JOHANNA (RN, CNP)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:JOHANNA
Last Name:SUTTER
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2839 WESTMORELAND AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-3318
Mailing Address - Country:US
Mailing Address - Phone:330-452-2531
Mailing Address - Fax:
Practice Address - Street 1:3743 BOETTLER OAKS DR
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-6227
Practice Address - Country:US
Practice Address - Phone:330-899-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.02312-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health