Individual
MR. ELIZABETH ANNE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
615 N 4TH AVE, DURANT, OK 74701-3907
(580) 775-3083
Mailing address
615 N 4TH AVE, DURANT, OK 74701-3907
(580) 775-3083
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
NEW
OK
Other
Enumeration date
05/19/2014
Last updated
05/19/2014
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