Individual
SUSAN M SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
15945 CLAYTON RD STE 120A, BALLWIN, MO 63011-2490
(636) 256-5000
(636) 256-5043
Mailing address
15945 CLAYTON RD STE 120A, BALLWIN, MO 63011-2490
(636) 256-5000
(636) 256-5043
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
2013039392
MO
Other
Enumeration date
10/03/2013
Last updated
02/10/2026
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