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Individual

MICHAEL DARIS SULLIVAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
NP

Contact information

Practice address
225 BALDWIN AVE, CHARLOTTE, NC 28204-3109
(704) 376-1605
Mailing address
225 BALDWIN AVE, CHARLOTTE, NC 28204-3109
(704) 376-1605
(704) 335-8448

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
20059
SC
363LF0000X
Family Nurse Practitioner
Primary
5017901
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1679935514
NC
05
NP4364
SC
Enumeration date
03/21/2016
Last updated
02/27/2024
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