Individual
MR. IWAN SUTANA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MBA, MSN, AGACNP-BC
Contact information
Practice address
300 PASTEUR DR, PALO ALTO, CA 94305-2200
(650) 723-2091
Mailing address
300 PASTEUR DR, STANFORD, CA 94305-2200
(650) 723-4000
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
695922
CA
163WC1500X
Community Health Registered Nurse
71519
CA
363L00000X
Nurse Practitioner
95007809
CA
363LA2100X
Acute Care Nurse Practitioner
Primary
95007809
CA
363LA2200X
Adult Health Nurse Practitioner
95007809
CA
363LG0600X
Gerontology Nurse Practitioner
95007809
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
695922
CA BRN
CA
01
—
71519
CALIFORNIA BOARD OF REGISTERED NURSING
CA
01
—
95007809
CALIFORNIA BOARD OF REGISTERED NURSING
CA
Enumeration date
04/21/2017
Last updated
12/28/2021
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