Individual
SALLY SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
971 LAKELAND DR, JACKSON, MS 39216-4643
(334) 279-1450
(334) 395-4110
Mailing address
PO BOX 4608, JACKSON, MS 39296-4608
(334) 279-1450
(334) 395-4110
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R892793
MS
Other
Enumeration date
05/24/2016
Last updated
05/24/2016
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