Individual
PATRICIA SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1400 EMELINE AVE, SANTA CRUZ, CA 95060-1976
(831) 454-4170
(831) 454-4663
Mailing address
1400 EMELINE AVE, SANTA CRUZ, CA 95060-1976
(831) 454-4170
(831) 454-4663
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
RN 655241
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
FHC70042F
SANTA CRUZ COUNTY MEDI-CAL SITE PROVIDER#
CA
01
—
FHC70044F
SANTA CRUZ COUNTY MEDI-CAL SITE PROVIDER#
CA
01
—
RN 655241
REGISTERED NURSE LICENSE#
CA
01
—
ZZZ91891Z
SANTA CRUZ COUNTY MEDICARE GROUP PTAN#
CA
01
—
ZZZ91892Z
SANTA CRUZ COUNTY MEDICARE GROUP PTAN#
CA
01
—
ZZZ92069Z
SANTA CRUZ COUNTY MEDICARE GROUP PTAN#
CA
Enumeration date
05/18/2015
Last updated
05/18/2015
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