Individual
MS. MARY MARTIN SULLENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN FNP MHS
Contact information
Practice address
2625 EDITH AVENUE, SUITE B, REDDING, CA 96001
(530) 225-7480
(530) 225-7293
Mailing address
3345 TIMBERCREEK DRIVE, REDDING, CA 96002
(530) 227-1840
(530) 225-7293
Taxonomy
Speciality
Code
Description
License number
State
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
NPF 6314
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NPF 6314
NURSE PRACT. LICENSE
CA
01
—
RN 229515
LICENSE NUMBER
CA
Enumeration date
03/27/2007
Last updated
07/08/2007
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