Individual
JASON ROBERT SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
720 WOOD ST, EUREKA, CA 95501-4413
(707) 268-2990
Mailing address
640 12TH ST APT 2, ARCATA, CA 95521-5864
(707) 689-9463
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
RN95135198
CA
Other
Enumeration date
08/04/2019
Last updated
08/04/2019
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