Individual
MIREILLE LISSETTE SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1201 N MULDOON RD, ANCHORAGE, AK 99504-6104
(907) 257-4700
Mailing address
1219 TOMAHAWK DR, JBER, AK 99505-1015
(907) 342-7399
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
07/06/2023
Last updated
07/06/2023
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