Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 2050 | CO |
NPI | 1790954816 |
---|---|
Provider Name | Ms. Patricia Sullivan |
First Address | Delta, CO 81416-1626 |
Second Address | Delta, CO 81416-1626 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2008 |
Last Update Date | 06/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
07020506 | (05) | CO |