Individual
CAROL SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CASE MANAGER
Contact information
Practice address
602 WEINRICH RD TRLR 6, LAS CRUCES, NM 88007-4857
(575) 496-1162
Mailing address
602 WEINRICH RD TRLR 6, LAS CRUCES, NM 88007-4857
(575) 339-4567
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
MT8614
NM
172M00000X
Mechanotherapist
MT8614
NM
173C00000X
Reflexologist
MT8614
NM
225700000X
Massage Therapist
Primary
MT8614
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
74481
—
NM
Enumeration date
08/03/2012
Last updated
01/30/2019
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