MEDICARE: CHRISTINA SULLIVAN DNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	217955	AR

General Provider Information

NPI Number	:	1932742400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA SULLIVAN DNP

Provider Business Mailing Address
First Line	:	774 POLVADERA ST
Second Line	:
City	:	COMMERCE TOWNSHIP
State	:	MI
Zip	:	48382-3951
Country	:	US
Telephone Number	:	952-836-9608
Fax Number	:

Provider Business Practice Location Address
First Line	:	774 POLVADERA ST
Second Line	:
City	:	COMMERCE TOWNSHIP
State	:	MI
Zip	:	48382-3951
Country	:	US
Telephone Number	:	952-836-9608
Fax Number	:

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

Provider Enumeration Date	:	10/28/2019
Last Update Date	:	12/11/2025

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