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Individual

JESSICA M SULLIVAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CNP

Contact information

Practice address
1405 EASTLAND DR, BLOOMINGTON, IL 61701-3514
(309) 661-2400
(309) 661-6266
Mailing address
1405 EASTLAND DR, BLOOMINGTON, IL 61701-3514
(309) 661-2400
(309) 661-6266

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209008299
IL

Other

Enumeration date
09/02/2010
Last updated
08/23/2013
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