Provider Demographics
NPI:1477026458
Name:SUTTON, NIESHA (LVN)
Entity Type:Individual
Prefix:
First Name:NIESHA
Middle Name:
Last Name:SUTTON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1144 MAGNOLIA
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-2162
Mailing Address - Country:US
Mailing Address - Phone:210-710-3787
Mailing Address - Fax:
Practice Address - Street 1:1144 MAGNOLIA
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-2162
Practice Address - Country:US
Practice Address - Phone:210-710-3787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX326892164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse