Individual
CHANTALL I SUTHERLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
87 WASHINGTON ST, RENSSELAER, NY 12144-2613
(518) 449-1142
Mailing address
PO BOX 148, RENSSELAER, NY 12144-0148
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
339815
NY
Other
Enumeration date
12/02/2020
Last updated
12/02/2020
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