Individual
MS. PAMELA SUE SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
GNP
Contact information
Practice address
40055 BOB HOPE DR STE B, RANCHO MIRAGE, CA 92270-3940
(760) 202-3946
(760) 770-4392
Mailing address
2160 COLONIAL BLVD, FORT MYERS, FL 33907-1410
(239) 931-7342
(239) 931-7385
Taxonomy
Speciality
Code
Description
License number
State
163WG0600X
Gerontology Registered Nurse
262478
CA
363LG0600X
Gerontology Nurse Practitioner
Primary
12764
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1409819
CIGNA
CA
01
—
4984336
AETNA
CA
Enumeration date
03/26/2007
Last updated
07/21/2022
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