Healthcare Provider Details

I. General information

NPI: 1497380778
Provider Name (Legal Business Name): JESSICA SULLIVAN APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2020
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 E CAMPUS MALL
MADISON WI
53715-1365
US

IV. Provider business mailing address

6720 HONEY BEE CT
DEFOREST WI
53532-9301
US

V. Phone/Fax

Practice location:
  • Phone: 608-265-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9871-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: