Provider Demographics
NPI:1346368958
Name:SUTTON, RETA (RN, CDE)
Entity Type:Individual
Prefix:
First Name:RETA
Middle Name:
Last Name:SUTTON
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2719 KNOB HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:ID
Mailing Address - Zip Code:83645-5325
Mailing Address - Country:US
Mailing Address - Phone:208-355-2443
Mailing Address - Fax:
Practice Address - Street 1:1226 W RIVER ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-7049
Practice Address - Country:US
Practice Address - Phone:208-331-1155
Practice Address - Fax:208-383-0190
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-18844163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator