Provider Demographics
NPI:1558080697
Name:SUTTER, JAIMIE JILL
Entity Type:Individual
Prefix:
First Name:JAIMIE
Middle Name:JILL
Last Name:SUTTER
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 1:17351 E WALNUT RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:NE
Mailing Address - Zip Code:68381-8041
Mailing Address - Country:US
Mailing Address - Phone:402-520-1434
Mailing Address - Fax:
Practice Address - Street 1:320 N 5TH ST
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310-2957
Practice Address - Country:US
Practice Address - Phone:402-223-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant