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NPI Code Detail

MEDICARE: REBECCA SULLIVAN LPN

MEDICARE: REBECCA SULLIVAN LPN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical NurseLP046208AZ

General Provider Information

NPI Number : 1023340049
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA SULLIVAN LPN
Provider Business Mailing Address
First Line : 1000 S MAIN ST
Second Line :
City : FLORENCE
State : AZ
Zip : 85132-8132
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1000 S MAIN ST
Second Line :
City : FLORENCE
State : AZ
Zip : 85132-8132
Country : US
Telephone Number : 520-723-6400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2010
Last Update Date : 02/01/2010

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Directions to “ REBECCA SULLIVAN LPN” Practice Location

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