Provider Demographics
NPI:1528775111
Name:SUNDERLAND, CATHY (RN)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:SUNDERLAND
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:HC 13 BOX 3104
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:UT
Mailing Address - Zip Code:84623-5001
Mailing Address - Country:US
Mailing Address - Phone:435-851-7734
Mailing Address - Fax:
Practice Address - Street 1:346 E 600 N
Practice Address - Street 2:
Practice Address - City:NEPHI
Practice Address - State:UT
Practice Address - Zip Code:84648-1245
Practice Address - Country:US
Practice Address - Phone:435-623-1940
Practice Address - Fax:435-623-1941
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT200798-3102163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool