Individual
PAUL B SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1200 W FAIRVIEW ST, COLFAX, WA 99111-9552
(509) 926-1770
(509) 228-9542
Mailing address
21980 E COUNTRY VISTA DR, STE 200, LIBERTY LAKE, WA 99019-6025
(509) 926-1770
(509) 228-9542
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP30005473
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
912153623
TAX ID
WA
05
—
9617499
—
WA
Enumeration date
08/30/2006
Last updated
11/08/2016
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