Provider Demographics
NPI:1801886114
Name:SUTHOFF, MARY PATRICIA (LPN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:PATRICIA
Last Name:SUTHOFF
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-3917
Mailing Address - Country:US
Mailing Address - Phone:251-633-3311
Mailing Address - Fax:251-633-3004
Practice Address - Street 1:1032 HILLCREST RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-3917
Practice Address - Country:US
Practice Address - Phone:251-633-3311
Practice Address - Fax:251-633-3004
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2-018527164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse