Individual
LAVERNE A SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
4210 FLAGSTAFF CV, FORT WAYNE, IN 46815-4417
(260) 489-9009
(260) 489-5057
Mailing address
5244 JEFFRIES LANE, NEWBURGH, IN 47630
(812) 454-1710
(260) 489-5057
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
37000748A
IN
Other
Enumeration date
06/26/2006
Last updated
07/01/2014
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