Provider Demographics
NPI:1669033379
Name:SUTTON, HOLLY ANNE
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:ANNE
Last Name:SUTTON
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 1:2217 FAWN RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-2580
Mailing Address - Country:US
Mailing Address - Phone:702-595-1694
Mailing Address - Fax:
Practice Address - Street 1:2217 FAWN RIDGE ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-2580
Practice Address - Country:US
Practice Address - Phone:702-595-1694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program