Individual
MRS. NINA NOELLA SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
2746 SHADOW VIEW DR, EUGENE, OR 97408-4610
(541) 345-0551
Mailing address
6653 JACOB LN, SPRINGFIELD, OR 97478-2110
(541) 484-5688
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
3320
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
784803
ASSOCIATED BODYWORK AND MASSAGE PROFESSIONALS
CO
Enumeration date
09/07/2010
Last updated
09/07/2010
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