Provider Demographics
NPI:1568780997
Name:SUTPHIN, MARY CHARLES (CNM)
Entity Type:Individual
Prefix:MRS
First Name:MARY CHARLES
Middle Name:
Last Name:SUTPHIN
Suffix:
Gender:F
Credentials:CNM
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Mailing Address - Street 1:400 ASHVILLE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-6134
Mailing Address - Country:US
Mailing Address - Phone:919-233-1311
Mailing Address - Fax:919-233-1685
Practice Address - Street 1:400 ASHVILLE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-6134
Practice Address - Country:US
Practice Address - Phone:919-233-1311
Practice Address - Fax:919-233-1685
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC035367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife