Provider Demographics
NPI:1598001869
Name:SUTTON, DANIELLE HATTIE (CRNP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:HATTIE
Last Name:SUTTON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:HATTIE
Other - Last Name:MCCAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1589 SULPHUR SPRING RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-2542
Mailing Address - Country:US
Mailing Address - Phone:410-536-5400
Mailing Address - Fax:410-737-2168
Practice Address - Street 1:5999 HARPERS FARM RD
Practice Address - Street 2:SUITE W250
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3013
Practice Address - Country:US
Practice Address - Phone:410-772-8822
Practice Address - Fax:410-772-9274
Is Sole Proprietor?:No
Enumeration Date:2012-12-14
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR174658363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD060988900Medicaid