Provider Demographics
NPI:1639403678
Name:SUTHERLAND, MALANA MICHELLE (NP)
Entity Type:Individual
Prefix:MS
First Name:MALANA
Middle Name:MICHELLE
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6148 WATERFORD LN
Mailing Address - Street 2:
Mailing Address - City:SORRENTO
Mailing Address - State:LA
Mailing Address - Zip Code:70778-3419
Mailing Address - Country:US
Mailing Address - Phone:225-450-2209
Mailing Address - Fax:225-356-1616
Practice Address - Street 1:6148 WATERFORD LN
Practice Address - Street 2:
Practice Address - City:SORRENTO
Practice Address - State:LA
Practice Address - Zip Code:70778-3419
Practice Address - Country:US
Practice Address - Phone:225-450-2209
Practice Address - Fax:225-356-1616
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05574363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily