Provider Demographics
NPI:1871062505
Name:SUTPHIN, LORRAINE A (APRN)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:A
Last Name:SUTPHIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1159 ROUTE 12A
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03781-5051
Mailing Address - Country:US
Mailing Address - Phone:908-894-3147
Mailing Address - Fax:
Practice Address - Street 1:1159 ROUTE 12A
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NH
Practice Address - Zip Code:03781-5051
Practice Address - Country:US
Practice Address - Phone:908-894-3147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-26
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH065049-23363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3117364Medicaid