Individual
MARY R. SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
222 S HERLONG AVE, ROCK HILL, SC 29732-1158
(803) 329-6711
(803) 329-5120
Mailing address
PO BOX 2974, ROCK HILL, SC 29732-4974
(803) 985-4551
(803) 985-4543
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
53474
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A9401
MEDCOST
—
05
—
AN0411
—
SC
Enumeration date
10/18/2005
Last updated
10/09/2007
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