Healthcare Provider Details

I. General information

NPI: 1467847871
Provider Name (Legal Business Name): LAURA MICHELE SULLIVAN M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 05/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 VANDERBILT PARK DR
ASHEVILLE NC
28803-1700
US

IV. Provider business mailing address

143 STATE ST
ASHEVILLE NC
28806-3341
US

V. Phone/Fax

Practice location:
  • Phone: 828-213-1740
  • Fax: 828-213-1742
Mailing address:
  • Phone: 828-213-1740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5010250
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number99797
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number5010250
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: