Individual
KEVIN JOHN SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
280 PALE SAN VITORES RD, TAMUNING, GU 96913-3615
(671) 647-4542
Mailing address
369 FARENHOLT AVE, TAMUNING, GU 96913-3106
(671) 787-8627
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
ARNP9237910
FL
367500000X
Certified Registered Nurse Anesthetist
CRNA000407
NV
367500000X
Certified Registered Nurse Anesthetist
Primary
NP0152
GU
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003321600
—
FL
01
—
G00N4
BCBS ATTACHED TO GRP 77329
FL
01
—
P01195017
RAILROAD MEDICARE
FL
Enumeration date
03/09/2011
Last updated
03/12/2020
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