Healthcare Provider Details

I. General information

NPI: 1639298540
Provider Name (Legal Business Name): LINDA SULLIVAN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 02/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 GOVERNMENT ST
MOBILE AL
36602-2614
US

IV. Provider business mailing address

3632 DAUPHIN ST
MOBILE AL
36608-1247
US

V. Phone/Fax

Practice location:
  • Phone: 251-433-8448
  • Fax: 251-460-5431
Mailing address:
  • Phone: 251-460-5280
  • Fax: 251-460-5339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1024547
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: