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Individual

MS. MARY THERESA O'SULLIVAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
5000 S 5TH AVE, HINES, IL 60141-3030
(708) 202-5988
Mailing address
5000 S 5TH AVE, HINES, IL 60141-3030
(708) 202-5988

Taxonomy

Speciality
Code
Description
License number
State
282NC0060X
Critical Access Hospital
209007963
IL
284300000X
Special Hospital
209007963
IL
363LC0200X
Critical Care Medicine Nurse Practitioner
Primary
209007963
IL

Other

Enumeration date
03/24/2010
Last updated
02/23/2015
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