Individual
ANNETTE NICHOLE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1025 MARSH ST, MANKATO, MN 56001-4752
(507) 625-4031
Mailing address
PO BOX 860912, MINNEAPOLIS, MN 55486-0912
(507) 284-2511
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
71763
MN
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
71763
MN
207R00000X
Internal Medicine Physician
125066220
IL
Other
Enumeration date
06/11/2015
Last updated
06/10/2025
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