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Individual
MS. PAMELA SUE SULLIVAN
Active
Individual
MS. PAMELA SUE SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
GNP
Taxonomy
Speciality
Code
Description
License number
State
163WG0600X
Gerontology Registered Nurse
262478
CA
363LG0600X
Gerontology Nurse Practitioner
Primary
12764
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1409819
CIGNA
CA
01
—
4984336
AETNA
CA
Enumeration date
03/26/2007
Last updated
07/21/2022
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