Individual
JAMES SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
4500 13TH ST, GULFPORT, MS 39501-2515
(228) 867-5000
Mailing address
4500 13TH ST, GULFPORT, MS 39501-2515
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
R882067
MS
367500000X
Certified Registered Nurse Anesthetist
Primary
901358
MS
Other
Enumeration date
11/20/2015
Last updated
05/27/2021
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