Individual
LISA SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3236 KIRKMAN ST, LAKE CHARLES, LA 70601-8640
(337) 480-2627
Mailing address
6523 SUN MEADOW LN, LAKE CHARLES, LA 70605-0449
(337) 478-9610
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
RN109596
LA
Other
Enumeration date
07/16/2012
Last updated
07/16/2012
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