MEDICARE: AMBER I SULLIVAN

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1417679275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER I SULLIVAN

Provider Business Mailing Address
First Line	:	PO BOX 3597
Second Line	:
City	:	PALMER
State	:	AK
Zip	:	99645-3597
Country	:	US
Telephone Number	:	907-952-1168
Fax Number	:	907-802-6100

Provider Business Practice Location Address
First Line	:	2529 CURLEW CIR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99502-1654
Country	:	US
Telephone Number	:	907-952-1168
Fax Number	:	907-802-6100

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

Provider Enumeration Date	:	09/16/2022
Last Update Date	:	09/16/2022

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Directions to “ AMBER I SULLIVAN ” Practice Location

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