Provider Demographics
NPI:1558521252
Name:SUTTER, TANYA ANN (LPN)
Entity Type:Individual
Prefix:MISS
First Name:TANYA
Middle Name:ANN
Last Name:SUTTER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 ARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:OH
Mailing Address - Zip Code:45005-1347
Mailing Address - Country:US
Mailing Address - Phone:937-550-4053
Mailing Address - Fax:
Practice Address - Street 1:101 ARTHUR AVE
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:OH
Practice Address - Zip Code:45005-1347
Practice Address - Country:US
Practice Address - Phone:937-550-4053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN112514 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse