Basic Information
| Provider Information | |||||||||
| NPI: | 1205406063 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUTCLIFFE | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | GARY | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 404 MAPLE ST | ||||||||
| Address2: | |||||||||
| City: | HURLEY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 545341147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9063640231 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5409 VERN HOLMES DR | ||||||||
| Address2: | |||||||||
| City: | STEVENS POINT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544828853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153441600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2021 | ||||||||
| LastUpdateDate: | 06/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 170571-30 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.