Individual
ANDREW SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
802 ACKERLY ST, LAMONI, IA 50140-1544
(641) 784-7911
Mailing address
302 NE 14TH ST, LEON, IA 50144-1206
(641) 446-2383
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1127604
IA
Other
Enumeration date
07/09/2015
Last updated
07/09/2015
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