Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | R9F81 | MO |
NPI | 1023071586 |
---|---|
Provider Name | Christine Sullivan |
First Address | Kansas City, MO 64108-2634 |
Second Address | Kansas City, MO 64108-2640 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2006 |
Last Update Date | 08/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
202396107 | (05) | MO |
C51404 | (02) | MO |