Individual
KATIE MARIE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
4650 S HAGADORN RD STE 100, EAST LANSING, MI 48823-5386
(517) 353-4830
(517) 355-2134
Mailing address
804 SERVICE RD STE A202, EAST LANSING, MI 48824-7015
(517) 432-3928
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704327523
MI
363L00000X
Nurse Practitioner
Primary
4704327523
MI
Other
Enumeration date
05/19/2022
Last updated
11/27/2023
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