Provider Demographics
NPI:1326381757
Name:SUTTON, LISA A (LPN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:SUTTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 BORDEN AVE
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:NY
Mailing Address - Zip Code:14530-1317
Mailing Address - Country:US
Mailing Address - Phone:585-322-3634
Mailing Address - Fax:
Practice Address - Street 1:57 BORDEN AVE
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:NY
Practice Address - Zip Code:14530-1317
Practice Address - Country:US
Practice Address - Phone:585-322-3634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-04
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311269-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse