Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 105958 | AZ |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 105958 | AZ |
NPI | 1043240328 |
---|---|
Provider Name | Jo M Sullivan |
First Address | Tucson, AZ 85723 |
Second Address | Tucson, AZ 85723 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 20/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
864357 | (05) | AZ |
Q18086 | (02) |