Provider Demographics
NPI:1659763605
Name:PHILLIPS, STEPHANIE SUTTER (CRNP)
Entity Type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:SUTTER
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:MCCLURE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:510 CHERRY ST NE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-1970
Mailing Address - Country:US
Mailing Address - Phone:256-353-7021
Mailing Address - Fax:
Practice Address - Street 1:510 CHERRY ST NE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-1970
Practice Address - Country:US
Practice Address - Phone:256-353-7021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-28
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-072812363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care