Provider Demographics
NPI:1497802771
Name:SUTTER, JOLENE CAROLINE (RD)
Entity Type:Individual
Prefix:MRS
First Name:JOLENE
Middle Name:CAROLINE
Last Name:SUTTER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WEST ST
Mailing Address - Street 2:APT 2111
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-1021
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 WEST ST
Practice Address - Street 2:APT 2111
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-1021
Practice Address - Country:US
Practice Address - Phone:860-268-1205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY952330133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered