Healthcare Provider Details

I. General information

NPI: 1720563208
Provider Name (Legal Business Name): KARI LYN SULLIVAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2018
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 N MICHIGAN AVE
SAGINAW MI
48602-4369
US

IV. Provider business mailing address

3854 COTTAGE GROVE CT
SAGINAW MI
48604-9529
US

V. Phone/Fax

Practice location:
  • Phone: 989-753-8453
  • Fax: 989-753-3519
Mailing address:
  • Phone: 989-928-2932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704281889
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: