MR. IWAN SUTANA MBA MSN AGACNP-BC NPI 1194250670

NPI Information

NPI: 1194250670
Provider Name: MR. IWAN SUTANA, MBA, MSN, AGACNP-BC
Classification: Nurse Practitioner - 363LA2100X
Entity Type: Individual

Specialization: Acute Care

PECOS Registration: Yes

Address:
300 PASTEUR DR
PALO ALTO, CA
ZIP 94305
Phone: (650) 723-2091
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MR. Iwan Sutana, MBA, MSN, AGACNP-BC is an acute care nurse practitioner in Palo Alto, CA. MR. Iwan Sutana, MBA, MSN, AGACNP-BC NPI is 1194250670. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

300 PASTEUR DR
PALO ALTO, CA
ZIP 94305-200
Phone: (650) 723-2091

The NPI 1194250670 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 4/21/2017 and was last updated on 12/28/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	163WC0200X	Registered Nurse	Critical Care Medicine	695922	CALIFORNIA	No
2	163WC1500X	Registered Nurse	Community Health	71519	CALIFORNIA	No
3	363L00000X	Nurse Practitioner		95007809	CALIFORNIA	No
4	363LA2200X	Nurse Practitioner	Adult Health	95007809	CALIFORNIA	No
5	363LG0600X	Nurse Practitioner	Gerontology	95007809	CALIFORNIA	No
6	363LA2100X	Nurse Practitioner	Acute Care	95007809	CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	695922	OTHER	CALIFORNIA	CA BRN
2	95007809	OTHER	CALIFORNIA	CALIFORNIA BOARD OF REGISTERED NURSING
3	71519	OTHER	CALIFORNIA	CALIFORNIA BOARD OF REGISTERED NURSING

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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