Individual
ALYSE MARIE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
950 BRITTANY PARK DR APT 423, ANTIOCH, TN 37013-5065
(530) 848-2648
Mailing address
950 BRITTANY PARK DR APT 423, ANTIOCH, TN 37013-5065
(530) 848-2648
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
5022149
NC
364SW0102X
Women's Health Clinical Nurse Specialist
Primary
SULL-MEKDS
NC
Other
Enumeration date
10/03/2023
Last updated
08/11/2025
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