Individual
WANDA J SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
765 S BONNER ST, RUSTON, LA 71270-5801
(318) 202-5935
(318) 202-5933
Mailing address
PO BOX 1839, RUSTON, LA 71273-1839
(318) 202-5935
(318) 202-5933
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN073140
LA
Other
Enumeration date
10/17/2006
Last updated
02/18/2016
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