Individual
MRS. KANDIS KAY SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
500 E VETERANS ST, TOMAH, WI 54660-3105
(608) 372-3971
Mailing address
1904 CEDAR CREEK DR, ROTHSCHILD, WI 54474-1461
(715) 470-0502
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
108168-030
WI
363LP2300X
Primary Care Nurse Practitioner
Primary
3857-33
WI
Other
Enumeration date
02/17/2010
Last updated
07/19/2016
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