Individual
CASEY MARIE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2095 HENRY TECKLENBURG DR, CHARLESTON, SC 29414-5733
(843) 402-1436
Mailing address
PO BOX 603484, CHARLOTTE, NC 28260-3484
(803) 765-1838
(803) 765-1732
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
28901
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300040951
—
IN
05
—
7100678460
—
KY
Enumeration date
06/02/2020
Last updated
02/14/2025
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