Individual
MARY-MARIE AUSTIN SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1134 N 500 W STE 102, PROVO, UT 84604-5569
(801) 341-5200
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 341-5200
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
8380179-1205
UT
Other
Enumeration date
04/05/2011
Last updated
09/14/2021
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