Individual
MRS. JACQUELINE RUTH SULLIVAN-OGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP-BC
Contact information
Practice address
401 HIGHWAY ST, UNDERWOOD, IA 51576
(712) 566-9148
(712) 566-9408
Mailing address
401 HIGHWAY ST, PO BOX 218, UNDERWOOD, IA 51576-0218
(712) 566-9148
(712) 566-9408
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
A-082459
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0498329
—
IA
01
—
110194
ARNP LICENSE
NE
01
—
270478
MEDICARE ID
IA
01
—
A- 082459
ARNP LICENSE
IA
01
—
P00338315
RAILROAD MEDICARE
IA
Enumeration date
05/19/2006
Last updated
06/18/2008
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