Individual
MS. EMILY BENNETT SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1614 NC HIGHWAY 56, CREEDMORE, NC 27522-1688
(336) 552-5961
Mailing address
307 KING ST, APT 2L, GREENSBORO, NC 27406-1688
(336) 552-5961
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-02197
NC
Other
Enumeration date
02/22/2010
Last updated
03/03/2017
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