Individual
MRS. GINA MARIE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
125 HOSPITAL DR, WATERTOWN, WI 53098-3303
(920) 390-7575
Mailing address
125 HOSPITAL DR, WATERTOWN, WI 53098-3303
(920) 390-7575
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
4989-33
WI
363LA2100X
Acute Care Nurse Practitioner
Primary
4989-33
WI
Other
Enumeration date
11/12/2012
Last updated
04/03/2017
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