Individual
LOUIS SULLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
720 N 129TH ST, OMAHA, NE 68154-6109
(402) 397-0670
(402) 397-0713
Mailing address
720 N 129TH ST, OMAHA, NE 68154-6109
(402) 397-0670
(402) 397-0713
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
895
NE
Other
Enumeration date
02/07/2006
Last updated
01/19/2016
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