Individual
MISS KENDELL ANN SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1396 OAK RIDGE CT, WILLOW SPRINGS, IL 60480-1369
(312) 865-0337
Mailing address
1396 OAK RIDGE CT, WILLOW SPRINGS, IL 60480-1369
(312) 865-0337
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041299781
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
209003976
IL
Other
Enumeration date
10/04/2007
Last updated
04/06/2012
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