Healthcare Provider Details

I. General information

NPI: 1144358557
Provider Name (Legal Business Name): GEORGE SULLIVAN C.A.R. L.M.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 5TH AVE SW
OLYMPIA WA
98502-5248
US

IV. Provider business mailing address

1825 FOREST HILL DR SE
OLYMPIA WA
98501-3736
US

V. Phone/Fax

Practice location:
  • Phone: 360-943-8470
  • Fax:
Mailing address:
  • Phone: 360-943-8470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA00013506
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: