Individual
SARA CAMILLE SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, LMT
Contact information
Practice address
20 PONDEROSA DR, LONOKE, AR 72086-3603
(501) 762-7951
Mailing address
20 PONDEROSA DR, LONOKE, AR 72086-3603
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R88651
AR
163W00000X
Registered Nurse
RN95310083
CA
225700000X
Massage Therapist
Primary
7055
AR
Other
Enumeration date
03/29/2024
Last updated
03/29/2024
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