Individual
LISA SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3580 ARCADE ST, VADNAIS HEIGHTS, MN 55127-7135
(651) 968-5201
(651) 968-5903
Mailing address
710 COMMERCE DR STE 200, WOODBURY, MN 55125-4925
(651) 968-5201
(651) 968-5903
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
14637
MN
Other
Enumeration date
09/05/2023
Last updated
11/10/2025
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