Individual
CRISTIANNA F SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD,
Contact information
Practice address
25 HOKANSON LN UPPR GRANDE, SALMON, ID 83467-5114
(208) 487-4839
Mailing address
25 HOKANSON LN UPPR GRANDE, SALMON, ID 83467-5114
(208) 487-4839
Taxonomy
Speciality
Code
Description
License number
State
133VN1004X
Pediatric Nutrition Registered Dietitian
Primary
C2813089
CA
Other
Enumeration date
03/04/2024
Last updated
03/04/2024
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