Provider Demographics
NPI:1205406063
Name:SUTCLIFFE, DOUGLAS GARY JR (NP-C)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:GARY
Last Name:SUTCLIFFE
Suffix:JR
Gender:M
Credentials:NP-C
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 328
Mailing Address - Street 2:
Mailing Address - City:SOUTH RANGE
Mailing Address - State:MI
Mailing Address - Zip Code:49963-0328
Mailing Address - Country:US
Mailing Address - Phone:906-364-1359
Mailing Address - Fax:
Practice Address - Street 1:N5241 US HIGHWAY 45
Practice Address - Street 2:
Practice Address - City:WATERSMEET
Practice Address - State:MI
Practice Address - Zip Code:49969-5115
Practice Address - Country:US
Practice Address - Phone:906-358-4588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704271786363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily