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Individual
LISA MYERS SULLIVAN
Active
Individual
LISA MYERS SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
23387
MS
390200000X
Student in an Organized Health Care Education/Training Program
0116017500
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07704363
—
MS
05
—
178238
—
AL
Enumeration date
05/02/2007
Last updated
11/11/2015
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