Provider Demographics
NPI:1508193616
Name:SUTTON, NATALIE LYNN (RN)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:LYNN
Last Name:SUTTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 HERSCHBACH DR
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-1815
Mailing Address - Country:US
Mailing Address - Phone:618-452-8504
Mailing Address - Fax:
Practice Address - Street 1:602 HERSCHBACH DR
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-1815
Practice Address - Country:US
Practice Address - Phone:618-452-8504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-10
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.372952163W00000X
MO2008008485163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse