Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 69284 | CO |
NPI | 1023018900 |
---|---|
Provider Name | Ms. Deborah A Sullivan |
First Address | Colorado Springs, CO 80909-1507 |
Second Address | Colorado Springs, CO 80909-1507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2005 |
Last Update Date | 24/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S57118 | (02) | CO |