Individual
CAROL SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1201 S LEE ST, APPLETON, WI 54915-3723
(920) 749-1072
Mailing address
1201 S LEE ST, APPLETON, WI 54915-3723
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
321357
WI
Other
Enumeration date
01/15/2017
Last updated
01/15/2017
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