Provider Demographics
NPI:1578313771
Name:SUTERA, ALLURAH DESTINY
Entity Type:Individual
Prefix:
First Name:ALLURAH
Middle Name:DESTINY
Last Name:SUTERA
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 1:116 W YANKTON ST
Mailing Address - Street 2:
Mailing Address - City:TABOR
Mailing Address - State:SD
Mailing Address - Zip Code:57063-2051
Mailing Address - Country:US
Mailing Address - Phone:661-618-4285
Mailing Address - Fax:
Practice Address - Street 1:116 W YANKTON ST
Practice Address - Street 2:
Practice Address - City:TABOR
Practice Address - State:SD
Practice Address - Zip Code:57063-2051
Practice Address - Country:US
Practice Address - Phone:661-618-4285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician