Provider Demographics
NPI:1083112288
Name:SUTTLE, SONYA (NP)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:
Last Name:SUTTLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:COLLETTSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28611-0009
Mailing Address - Country:US
Mailing Address - Phone:828-754-2409
Mailing Address - Fax:
Practice Address - Street 1:4330 COLLETTSVILLE RD
Practice Address - Street 2:
Practice Address - City:COLLETTSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28611-9000
Practice Address - Country:US
Practice Address - Phone:828-754-2409
Practice Address - Fax:828-754-2418
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5010202363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5010202OtherNCBON/MEDICAL BOARD