Individual
MRS. LAUREN SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
180 DEBUYS RD, BILOXI, MS 39531-4402
(228) 669-0662
Mailing address
10947 WATERSIDE DR, GULFPORT, MS 39503-6058
(228) 669-0662
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
885877
MS
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
901959
MS
Other
Enumeration date
01/16/2017
Last updated
02/09/2017
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