Individual
GEORGE BLAKE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
400 WARREN AVE STE 200, BREMERTON, WA 98337-1467
(360) 377-3776
Mailing address
16310 REITAN RD NE, BAINBRIDGE ISLAND, WA 98110-3047
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
AP61014314
WA
Other
Enumeration date
10/28/2019
Last updated
10/28/2019
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