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Individual

MRS. TARA ROBERTA SULLIVAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RN,IBCLC,LCCE

Contact information

Practice address
24808 BOSTON ST, DEARBORN, MI 48124-4411
(313) 618-4206
Mailing address
24808 BOSTON ST, DEARBORN, MI 48124-4411
(313) 618-4206

Taxonomy

Speciality
Code
Description
License number
State
163WL0100X
Lactation Consultant (Registered Nurse)
Primary
4704245099
MI

Other

Enumeration date
05/31/2020
Last updated
05/31/2020
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