Provider Demographics
NPI:1225855679
Name:SUTTON, ANGELA (RN)
Entity type:Individual
Prefix:
First Name:ANGELA
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 1:4860 ONONDAGA RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-2241
Mailing Address - Country:US
Mailing Address - Phone:315-426-3420
Mailing Address - Fax:315-426-3424
Practice Address - Street 1:4860 ONONDAGA RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215-2241
Practice Address - Country:US
Practice Address - Phone:315-426-3420
Practice Address - Fax:315-426-3424
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY528575-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse