Healthcare Provider Details

I. General information

NPI: 1578692638
Provider Name (Legal Business Name): D'ANNA LINDA-MARIE SULLIVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 BERGQUIST DR
LACKLAND A F B TX
78236-9907
US

IV. Provider business mailing address

2200 BERGQUIST DR
LACKLAND AFB TX
78236-9907
US

V. Phone/Fax

Practice location:
  • Phone: 210-292-2988
  • Fax:
Mailing address:
  • Phone: 210-679-0569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: