Individual
ICEL R SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
888 SWIFT BLVD, RICHLAND, WA 99352-3514
(509) 946-4611
Mailing address
550 GAGE BLVD STE 101, RICHLAND, WA 99352-9532
(971) 358-2390
(509) 627-2983
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN00164194
WA
363LP0200X
Pediatric Nurse Practitioner
Primary
AP61060250
WA
Other
Enumeration date
02/20/2020
Last updated
11/11/2021
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