Individual
MARLENA SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
104 CONTEMPO AVE, WEST MONROE, LA 71291-5312
(337) 807-1360
(337) 807-1364
Mailing address
5959 S SHERWOOD FOREST BLVD, BATON ROUGE, LA 70816-6038
(337) 807-1360
(225) 765-9196
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
341165
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
LA
Other
Enumeration date
04/12/2021
Last updated
05/24/2024
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