Individual
MRS. CAROLYN ANNE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AC PNP
Contact information
Practice address
3231 S NATIONAL AVE, SUITE 115, SPRINGFIELD, MO 65807-7304
(417) 885-0824
(417) 890-4174
Mailing address
PO BOX 505164, SAINT LOUIS, MO 63150-5164
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
363LP0222X
Critical Care Pediatric Nurse Practitioner
Primary
2015003901
MO
363LP0222X
Critical Care Pediatric Nurse Practitioner
209009257
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1225306269
—
MO
Enumeration date
12/05/2011
Last updated
11/19/2015
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