Provider Demographics
NPI:1669710406
Name:SUTTER, NICOLE RACHELLE (PA-C)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:RACHELLE
Last Name:SUTTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:RACHELLE
Other - Last Name:BANFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 12
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0012
Mailing Address - Country:US
Mailing Address - Phone:866-747-2455
Mailing Address - Fax:406-329-1927
Practice Address - Street 1:3055 N RESERVE ST STE D
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1395
Practice Address - Country:US
Practice Address - Phone:406-327-7000
Practice Address - Fax:406-329-1927
Is Sole Proprietor?:No
Enumeration Date:2013-01-30
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT35302363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant