Individual
MELODY L SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
477 23RD ST, OGDEN, UT 84401-1507
(801) 399-7109
Mailing address
477 23RD ST, OGDEN, UT 84401-1507
(801) 399-7109
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
341490-3102
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
529949454073
—
UT
05
—
876000308011
—
UT
05
—
998877666002
—
UT
Enumeration date
07/10/2008
Last updated
07/10/2008
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