Provider Demographics
NPI:1093044273
Name:SUTA, LOUISE ABELL (LAC)
Entity Type:Individual
Prefix:MS
First Name:LOUISE
Middle Name:ABELL
Last Name:SUTA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:LOUISA
Other - Middle Name:ABELL
Other - Last Name:SUTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:9335 TAKILMA RD
Mailing Address - Street 2:
Mailing Address - City:CAVE JUNCTION
Mailing Address - State:OR
Mailing Address - Zip Code:97523-9831
Mailing Address - Country:US
Mailing Address - Phone:541-415-0250
Mailing Address - Fax:
Practice Address - Street 1:9335 TAKILMA RD
Practice Address - Street 2:
Practice Address - City:CAVE JUNCTION
Practice Address - State:OR
Practice Address - Zip Code:97523-9831
Practice Address - Country:US
Practice Address - Phone:541-415-0250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORACO1281171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist