Provider Demographics
NPI:1093947178
Name:SUTERA, KRISTIN MARIE (BSN, RN)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MARIE
Last Name:SUTERA
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 79TH ST
Mailing Address - Street 2:APT 2D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3646
Mailing Address - Country:US
Mailing Address - Phone:917-816-4798
Mailing Address - Fax:
Practice Address - Street 1:314 79TH ST
Practice Address - Street 2:APT 2D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3646
Practice Address - Country:US
Practice Address - Phone:917-816-4798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21445103163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse