Individual
LISA CAROL SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
501 MORRIS ST, CHARLESTON, WV 25301-1326
(304) 388-5432
Mailing address
3200 MACCORKLE AVENUE, CHARLESTON, WV 25304
(304) 388-5590
(304) 388-8238
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APRN63044NP
WV
Other
Enumeration date
07/29/2013
Last updated
12/30/2015
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