Individual
JESSIE LYNN SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3075 ORCHARD VISTA DR SE, GRAND RAPIDS, MI 49546-7069
(616) 301-8000
Mailing address
17160 130TH AVE, NUNICA, MI 49448-9450
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704301679
MI
363LF0000X
Family Nurse Practitioner
Primary
4704301679
MI
Other
Enumeration date
03/11/2020
Last updated
10/27/2025
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