Provider Demographics
NPI:1487402301
Name:SUTTERFIELD, MARY WATTICK (APRN FNP-C)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:WATTICK
Last Name:SUTTERFIELD
Suffix:
Gender:F
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1244 STORRS RD
Mailing Address - Street 2:
Mailing Address - City:STORRS
Mailing Address - State:CT
Mailing Address - Zip Code:06268-2200
Mailing Address - Country:US
Mailing Address - Phone:860-456-9720
Mailing Address - Fax:
Practice Address - Street 1:12A LEDGEBROOK DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD CENTER
Practice Address - State:CT
Practice Address - Zip Code:06250-1690
Practice Address - Country:US
Practice Address - Phone:860-423-2960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-07
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13132363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily