Provider Demographics
NPI:1811750805
Name:SUTTER, ALLISON ROSE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:ALLISON
Middle Name:ROSE
Last Name:SUTTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2065 S. CENTER ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48519
Mailing Address - Country:US
Mailing Address - Phone:810-235-2004
Mailing Address - Fax:
Practice Address - Street 1:2065 S. CENTER ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48519
Practice Address - Country:US
Practice Address - Phone:810-235-2004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601012154363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant