Individual
KEVIN SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
66 PAVILION AVE, PROVIDENCE, RI 02905-1522
(401) 461-9110
(401) 461-9110
Mailing address
66 PAVILION AVE, PROVIDENCE, RI 02905-1522
(401) 461-9110
(401) 461-9110
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
Primary
RN34014
RI
Other
Enumeration date
04/02/2014
Last updated
04/02/2014
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