Provider Demographics
NPI:1518621895
Name:SUTTON, COURTNEY E
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:E
Last Name:SUTTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 VIRGINIA AVE APT A
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63111-2430
Mailing Address - Country:US
Mailing Address - Phone:314-396-0137
Mailing Address - Fax:
Practice Address - Street 1:6100 VIRGINIA AVE APT A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63111-2430
Practice Address - Country:US
Practice Address - Phone:314-396-0137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-23
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker