Healthcare Provider Details

I. General information

NPI: 1063408912
Provider Name (Legal Business Name): BARBARA SULLIVAN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1444 S POTOMAC ST SUITE 300
AURORA CO
80012-4508
US

IV. Provider business mailing address

PO BOX 848601
BOSTON MA
02284-8601
US

V. Phone/Fax

Practice location:
  • Phone: 303-750-0822
  • Fax: 303-750-1298
Mailing address:
  • Phone: 303-295-8737
  • Fax: 303-298-1862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number69931
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: