Provider Demographics
NPI:1962008169
Name:SUTHARD, SHAWNEE MARIE
Entity Type:Individual
Prefix:
First Name:SHAWNEE
Middle Name:MARIE
Last Name:SUTHARD
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:PO BOX 293
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25053-0293
Mailing Address - Country:US
Mailing Address - Phone:304-590-7611
Mailing Address - Fax:
Practice Address - Street 1:594 VENTURE DRIVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25053-0293
Practice Address - Country:US
Practice Address - Phone:304-590-7611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-11
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant