Individual
STAYCE K SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
515 NORTHGATE DR., STE. 101, SAN RAFAEL, CA 94903-9490
(415) 202-9990
(415) 202-0102
Mailing address
42 GRANDE PASEO, SAN RAFAEL, CA 94903-1546
(509) 995-7310
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
95012073
CA
Other
Enumeration date
08/12/2019
Last updated
08/12/2019
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