Provider Demographics
NPI:1427222009
Name:SUTPHEN, STEPHANIE (APN)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:SUTPHEN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 CROSSWICKS RD STE 11
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-2602
Mailing Address - Country:US
Mailing Address - Phone:609-298-7204
Mailing Address - Fax:609-298-0491
Practice Address - Street 1:231 CROSSWICKS RD STE 11
Practice Address - Street 2:
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505-2602
Practice Address - Country:US
Practice Address - Phone:609-298-7204
Practice Address - Fax:609-298-0491
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN07722100363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJNN77221OtherSTATE LICENSE NUMBER