Provider Demographics
NPI:1235290743
Name:SUTHERLAND, DEBBORA (GNP, BC)
Entity Type:Individual
Prefix:MS
First Name:DEBBORA
Middle Name:
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:GNP, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 BOND STREET DVA SPOPC
Mailing Address - Street 2:MHICM
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104
Mailing Address - Country:US
Mailing Address - Phone:413-731-6000
Mailing Address - Fax:413-788-4617
Practice Address - Street 1:25 BOND ST.
Practice Address - Street 2:SPOPC
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104
Practice Address - Country:US
Practice Address - Phone:413-731-6000
Practice Address - Fax:413-788-4617
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000698363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology