Individual
MARIA SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3440 DE PAUL LN STE 113, BRIDGETON, MO 63044-3546
(314) 942-6464
Mailing address
3440 DE PAUL LN STE 113, BRIDGETON, MO 63044-3546
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
2020030529
MO
363AM0700X
Medical Physician Assistant
PA56937
CA
Other
Enumeration date
04/22/2019
Last updated
03/06/2024
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