Individual
REBECCA J SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4117 S 120TH ST # 1250, OMAHA, NE 68137-1250
(402) 719-1194
Mailing address
905 WILMONT ST, FREMONT, NE 68025-6214
(402) 719-1194
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
205
NE
Other
Enumeration date
11/02/2021
Last updated
11/02/2021
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