Individual
IDA E SUTHERLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
600 RANDOLPH ST, RADFORD, VA 24141-2428
(540) 639-5300
(540) 639-4653
Mailing address
600 RANDOLPH ST, RADFORD, VA 24141-2428
(540) 639-5300
(540) 639-4653
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024167940
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1003925108
VA PREMIER
VA
05
—
1003925108
—
VA
Enumeration date
08/30/2006
Last updated
07/21/2022
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