Healthcare Provider Details

I. General information

NPI: 1255099230
Provider Name (Legal Business Name): LINDSAY NICOLE SULLIVAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDSAY NICOLE PERSON RN

II. Dates (important events)

Enumeration Date: 12/07/2021
Last Update Date: 12/07/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 NORMAN DR NE
CEDAR RAPIDS IA
52402-1423
US

IV. Provider business mailing address

254 NORMAN DR NE
CEDAR RAPIDS IA
52402-1423
US

V. Phone/Fax

Practice location:
  • Phone: 319-360-9536
  • Fax:
Mailing address:
  • Phone: 319-360-9536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number111318
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: