Provider Demographics
NPI:1184773194
Name:SUTTON, ALICE M (RN,LMT)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:M
Last Name:SUTTON
Suffix:
Gender:F
Credentials:RN,LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 74872
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44194-4872
Mailing Address - Country:US
Mailing Address - Phone:419-531-3500
Mailing Address - Fax:419-531-1877
Practice Address - Street 1:3425 EXECUTIVE PKWY
Practice Address - Street 2:SUITE 230
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1326
Practice Address - Country:US
Practice Address - Phone:419-531-3500
Practice Address - Fax:419-531-1877
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33-00-8897163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)