Individual
MRS. MARY ELLEN SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
GNP-BC
Contact information
Practice address
111 DOCTOR CIR, COLUMBIA, SC 29203-6502
(800) 491-0909
Mailing address
111 DOCTOR CIR, COLUMBIA, SC 29203-6502
(800) 491-0909
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
3428
SC
Other
Enumeration date
12/25/2007
Last updated
11/09/2022
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