Individual
MICHAEL SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP-BC
Contact information
Practice address
517 W GRACE ST, RICHMOND, VA 23220-4911
(804) 783-2505
Mailing address
517 W GRACE ST, RICHMOND, VA 23220-4911
(804) 783-2505
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
0024172854
VA
Other
Enumeration date
09/28/2015
Last updated
09/28/2015
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