Individual
MRS. AMANDA MARIE SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.P.N,
Contact information
Practice address
610 N MAIN ST, FALL RIVER, WI 53932-9570
(920) 382-5666
Mailing address
610 N MAIN ST, FALL RIVER, WI 53932-9570
(920) 382-5666
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
304840-31
WI
Other
Enumeration date
03/12/2012
Last updated
03/13/2012
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