Provider Demographics
NPI:1952817397
Name:SUTTON, TERESA MARIE (NP)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIE
Last Name:SUTTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:MARIE
Other - Last Name:LINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1399 N BALDWIN AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-1913
Mailing Address - Country:US
Mailing Address - Phone:765-660-7550
Mailing Address - Fax:656-624-4677
Practice Address - Street 1:1399 N BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-1913
Practice Address - Country:US
Practice Address - Phone:765-660-7550
Practice Address - Fax:765-662-4467
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28145560A363LF0000X
IN71007683A363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300021011Medicaid