Individual
KATHLEEN M. SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
20511 SUNSET LN, LAGO VISTA, TX 78645-6245
(860) 460-1211
(860) 760-6113
Mailing address
20511 SUNSET LN, LAGO VISTA, TX 78645-6245
(860) 460-1211
(860) 460-1211
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
NPP37789
RI
Other
Enumeration date
09/18/2008
Last updated
09/11/2018
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