Provider Demographics
NPI:1194840082
Name:NISHIMOTO SUTTON, ANNA (RN, PHN, MSN)
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:
Last Name:NISHIMOTO SUTTON
Suffix:
Gender:F
Credentials:RN, PHN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2719 CUMBERLAND PL
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-2908
Mailing Address - Country:US
Mailing Address - Phone:650-430-1773
Mailing Address - Fax:
Practice Address - Street 1:137 NORTH COTTONWOOD STREET
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695
Practice Address - Country:US
Practice Address - Phone:530-666-8575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA577249163WC0400X, 163WC1500X, 163WM0102X, 163WP0200X, 163WP1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WC0400XNursing Service ProvidersRegistered NurseCase Management
Not Answered163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Not Answered163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
Not Answered163WP0200XNursing Service ProvidersRegistered NursePediatrics
Not Answered163WP1700XNursing Service ProvidersRegistered NursePerinatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA577249OtherNURSING LICENSE