MEDICARE: MS. CHRISTINE ANN SULLIVAN CNM, FNP, PHD, MSN

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
1	163WW0101X	Ambulatory Women's Health Care Registered Nurse	393917	CA
2	363LF0000X	Family Nurse Practitioner	13187	CA
3	367A00000X	Advanced Practice Midwife	548	CA

General Provider Information

NPI Number	:	1265424121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHRISTINE ANN SULLIVAN CNM, FNP, PHD, MSN

Provider Business Mailing Address
First Line	:	34800 BOB WILSON DR
Second Line	:	BLDG 6 5TH FLOOR CREDENTIALING
City	:	SAN DIEGO
State	:	CA
Zip	:	92134-5000
Country	:	US
Telephone Number	:	619-532-6471
Fax Number	:

Provider Business Practice Location Address
First Line	:	34800 BOB WILSON DR
Second Line	:	BLDG 6 5TH FLOOR CREDENTIALING
City	:	SAN DIEGO
State	:	CA
Zip	:	92134-5000
Country	:	US
Telephone Number	:	619-532-6471
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	03/10/2015

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