Individual
HEATHER SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
110 10TH ST SE, BANDON, OR 97411-9157
(541) 347-2313
(541) 347-2015
Mailing address
110 10TH ST SE, BANDON, OR 97411-9157
(541) 347-2313
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
200341475RN
OR
363LF0000X
Family Nurse Practitioner
117094
AK
363LF0000X
Family Nurse Practitioner
Primary
201607221NP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500766156
—
OR
Enumeration date
09/01/2016
Last updated
04/15/2026
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