Provider Demographics
NPI:1407883507
Name:SUTTER, DENISE A (NP)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:A
Last Name:SUTTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:SUITE M-170
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-381-5060
Mailing Address - Fax:269-381-1655
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE M-170
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-381-5060
Practice Address - Fax:269-381-1655
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704170332363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
5008705570OtherBCBS PIN
383148262OtherEIN-HEALTHCARE MIDWEST
Q58927Medicare UPIN
MI0N83150003Medicare ID - Type Unspecified