Individual
JOAN MARIE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
1900 WEALTHY ST SE STE 300, GRAND RAPIDS, MI 49506-2969
(616) 774-8345
Mailing address
100 MICHIGAN ST NE, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601003370
MI
363AS0400X
Surgical Physician Assistant
1046093
OK
Other
Enumeration date
10/23/2006
Last updated
01/12/2026
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