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Individual

MS. STEPHANIE M. SULLIVAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MSN, NP

Contact information

Practice address
2001 DWIGHT WAY, SECOND FLOOR, BERKELEY, CA 94704-2608
(510) 204-5770
(510) 204-5749
Mailing address
2001 DWIGHT WAY, SECOND FLOOR, BERKELEY, CA 94704-2608
(510) 204-5770
(510) 204-5749

Taxonomy

Speciality
Code
Description
License number
State
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
566514
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
005665140
CA
Enumeration date
06/12/2006
Last updated
01/11/2022
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