Individual
JEANNETTE M SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
203 WINSTON DR, MARSHALL, MI 49068-8526
(269) 789-4380
Mailing address
203 WINSTON DR, MARSHALL, MI 49068-8526
(269) 789-4380
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704196183
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704196183
STATE LICENSE NUMBER
MI
Enumeration date
08/25/2006
Last updated
03/31/2025
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