Provider Demographics
NPI:1982394821
Name:SUTTER, GRACE ANN (STUDENT)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:ANN
Last Name:SUTTER
Suffix:
Gender:F
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17500 WYMAN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-4028
Mailing Address - Country:US
Mailing Address - Phone:314-413-6942
Mailing Address - Fax:
Practice Address - Street 1:17500 WYMAN RIDGE DR
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025-4028
Practice Address - Country:US
Practice Address - Phone:314-413-6942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program