Individual
MACKENZIE D SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
801 N BEDELL AVE, DEL RIO, TX 78840-4112
(830) 778-3781
Mailing address
PO BOX 1527, DEL RIO, TX 78841-1527
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP136337
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
380723201
—
TX
Enumeration date
01/05/2018
Last updated
11/30/2022
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