Provider Demographics
NPI:1366112294
Name:SUTHERLIN, DEANNA
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:SUTHERLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 E STATE ROAD 14
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:IN
Mailing Address - Zip Code:47943-8019
Mailing Address - Country:US
Mailing Address - Phone:219-204-1736
Mailing Address - Fax:
Practice Address - Street 1:2115 E STATE ROAD 14
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:IN
Practice Address - Zip Code:47943-8019
Practice Address - Country:US
Practice Address - Phone:219-204-1736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator