Provider Demographics
NPI:1164033072
Name:SAUTTER, MARION
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:
Last Name:SAUTTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 W KAIBAB LN LOT 3
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-6272
Mailing Address - Country:US
Mailing Address - Phone:928-600-2538
Mailing Address - Fax:
Practice Address - Street 1:1450 W KAIBAB LN LOT 3
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-6272
Practice Address - Country:US
Practice Address - Phone:928-600-2538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program