Individual
MS. LISA RENEE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
44305 HARMONY LN, BELLEVILLE, MI 48111-2449
(734) 716-5588
Mailing address
44305 HARMONY LN, BELLEVILLE, MI 48111-2449
(734) 716-5588
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601005958
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5601005958
STATE LICENSE
MI
Enumeration date
09/14/2010
Last updated
01/08/2014
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