Individual
ELISE D SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
745 RUSSELL ST, CRAIG, CO 81625-2019
(970) 824-8233
Mailing address
745 RUSSELL ST, CRAIG, CO 81625-2019
(970) 824-8233
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
54286
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34877215
—
CO
Enumeration date
06/22/2007
Last updated
11/21/2024
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