Healthcare Provider Details

I. General information

NPI: 1992041602
Provider Name (Legal Business Name): PHOEBE MANNING SULLIVAN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2012
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 E CAMPUS MALL # 6140
MADISON WI
53715-1365
US

IV. Provider business mailing address

333 E CAMPUS MALL # 6140
MADISON WI
53715-1365
US

V. Phone/Fax

Practice location:
  • Phone: 608-262-5660
  • Fax:
Mailing address:
  • Phone: 608-262-5660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number148874-32
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number193620-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: