Individual
ALICIA KIM SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
441 S STATE ROUTE 157 STE 102, EDWARDSVILLE, IL 62025-4017
(618) 254-2273
(618) 254-8476
Mailing address
441 S STATE ROUTE 157 STE 102, EDWARDSVILLE, IL 62025-4017
(618) 254-2273
(618) 254-8476
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2093022275
IL
Other
Enumeration date
12/02/2020
Last updated
12/02/2020
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