MEDICARE: MRS. LOUISE MARY O'SULLIVAN L.AC., R.N., L.M.P.

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	171100000X	Acupuncturist	AC 60083875	WA

General Provider Information

NPI Number	:	1285968396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LOUISE MARY O'SULLIVAN L.AC., R.N., L.M.P.

Provider Business Mailing Address
First Line	:	1145 NW 58TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98107-2915
Country	:	US
Telephone Number	:	206-354-3444
Fax Number	:

Provider Business Practice Location Address
First Line	:	5424 BALLARD AVE NW
Second Line	:	SUITE 301
City	:	SEATTLE
State	:	WA
Zip	:	98107-4046
Country	:	US
Telephone Number	:	206-354-3444
Fax Number	:

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

Provider Enumeration Date	:	09/22/2009
Last Update Date	:	09/22/2009

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