Individual
MR. KERMIT C SULLIVAN III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1303 E GREENHURST RD, NAMPA, ID 83686-7216
(208) 468-7820
Mailing address
231 N TURTLE DOVE WAY, NAMPA, ID 83651-8363
(208) 442-4354
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-182
ID
Other
Enumeration date
03/05/2007
Last updated
07/08/2007
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