Individual
SANDRA SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6700 W OVERLAND RD, BOISE, ID 83709-2032
(208) 319-4587
(208) 377-3883
Mailing address
6700 W OVERLAND RD, BOISE, ID 83709-2032
(208) 319-4587
(208) 377-3883
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A0000141
—
ID
Enumeration date
11/08/2021
Last updated
11/08/2021
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