Provider Demographics
NPI:1538140330
Name:SUTPHIN, ANDREA YVONNE (R N)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:YVONNE
Last Name:SUTPHIN
Suffix:
Gender:F
Credentials:R N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 BLACKBIRD DR SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-9013
Mailing Address - Country:US
Mailing Address - Phone:505-242-2350
Mailing Address - Fax:
Practice Address - Street 1:100 JOHN DANTIS RD SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87151-0100
Practice Address - Country:US
Practice Address - Phone:505-839-8837
Practice Address - Fax:505-839-8989
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR14245163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult