Individual
HAZEL LEANN SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AG- ACNP
Contact information
Practice address
1314 19TH AVE, MERIDIAN, MS 39301-4116
(601) 483-0011
Mailing address
2016 LITTLE ROCK DECATUR RD, DECATUR, MS 39327-9118
(601) 416-7816
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
R854988
MS
Other
Enumeration date
01/18/2014
Last updated
01/18/2014
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