Individual
ELISE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3635 VISTA AVE, SAINT LOUIS, MO 63110-2539
(314) 268-5558
Mailing address
2763 TIARA DR, ARNOLD, MO 63010-3027
(314) 517-6078
(314) 268-5786
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2019044085
MO
Other
Enumeration date
09/23/2019
Last updated
11/06/2024
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