Individual
MRS. KRISTINE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
101 DATES DR, ITHACA, NY 14850-1342
(607) 274-4011
Mailing address
101 DATES DR, ITHACA, NY 14850-1342
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
345036
NY
363LF0000X
Family Nurse Practitioner
F345036
NY
Other
Enumeration date
09/17/2019
Last updated
09/21/2021
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