MEDICARE: DR. LINDA J. SULLIVAN DOM

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	859	NM

General Provider Information

NPI Number	:	1346320967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDA J. SULLIVAN DOM

Provider Business Mailing Address
First Line	:	5341 WYOMING BLVD NE
Second Line	:	SUITE C
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-3164
Country	:	US
Telephone Number	:	505-822-1490
Fax Number	:	505-822-1490

Provider Business Practice Location Address
First Line	:	5341 WYOMING BLVD NE
Second Line	:	SUITE C
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-3164
Country	:	US
Telephone Number	:	505-822-1490
Fax Number	:	505-822-1490

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	07/08/2007

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