Healthcare Provider Details

I. General information

NPI: 1538402243
Provider Name (Legal Business Name): SEANEEN SCOTT SULLINGER MSN, RN, PHN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2013
Last Update Date: 04/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 OCEAN PINES LN
PEBBLE BEACH CA
93953-3077
US

IV. Provider business mailing address

19 OCEAN PINES LN
PEBBLE BEACH CA
93953-3077
US

V. Phone/Fax

Practice location:
  • Phone: 831-233-0142
  • Fax:
Mailing address:
  • Phone: 831-233-0142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number425272
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number53915
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: