Provider Demographics
NPI:1982788790
Name:SUTER, RUTHANNA (APRN BC)
Entity Type:Individual
Prefix:
First Name:RUTHANNA
Middle Name:
Last Name:SUTER
Suffix:
Gender:F
Credentials:APRN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 ST HWY 30
Mailing Address - Street 2:SUITE 204
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010
Mailing Address - Country:US
Mailing Address - Phone:518-842-8185
Mailing Address - Fax:518-842-8189
Practice Address - Street 1:5010 ST HWY 30
Practice Address - Street 2:SUITE 204
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010
Practice Address - Country:US
Practice Address - Phone:518-842-8185
Practice Address - Fax:518-842-8189
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3342041363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01515397Medicaid
S83686Medicare UPIN
NY01515397Medicaid