MEDICARE: LEE MARY SULKIN NP

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	363LA2200X	Adult Health Nurse Practitioner	668028	TX

General Provider Information

NPI Number	:	1417215302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEE MARY SULKIN NP

Provider Business Mailing Address
First Line	:	1100 ALLIED DRIVE
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093
Country	:	US
Telephone Number	:	469-744-4433
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 ALLIED DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-5348
Country	:	US
Telephone Number	:	469-744-4433
Fax Number	:

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

Provider Enumeration Date	:	04/27/2012
Last Update Date	:	04/27/2012

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