Provider Demographics
NPI:1386804342
Name:SUTTER, SALOME JEMUTAI (NP)
Entity type:Individual
Prefix:
First Name:SALOME
Middle Name:JEMUTAI
Last Name:SUTTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:SALOME
Other - Middle Name:
Other - Last Name:SUTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1120 FIREWHEEL PL
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-5394
Mailing Address - Country:US
Mailing Address - Phone:469-951-0477
Mailing Address - Fax:
Practice Address - Street 1:1120 FIREWHEEL PL
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-5394
Practice Address - Country:US
Practice Address - Phone:469-951-0477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-13
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142342207Q00000X
171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No171W00000XOther Service ProvidersContractor