Individual
MARCIA SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3056 S KINNICKINNIC AVE, MILWAUKEE, WI 53207-2521
(414) 769-4900
Mailing address
4425 N PORT WASHINGTON RD, ATTN: CLINIC CREDENTIALING, GLENDALE, WI 53212-1082
(414) 769-4900
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
935
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41176400
—
WI
Enumeration date
11/01/2006
Last updated
05/25/2011
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