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General NPI Number Information
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NPI Number | 1003468646
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Entity Type | Individual
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Provider Name | KATHERINE ANN SULLIVAN APRN, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/14/2019
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Last Update Date | 09/20/2021
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Provider Practice Location Address
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Address Line | 8501 W HIGGINS RD STE 601
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City | CHICAGO
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State | IL
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Zip | 60631-2816
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Country | US
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Telephone | 773-644-5535
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Fax | 773-644-5582
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Provider Business Mailing Address
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Address Line | 8501 W HIGGINS RD STE 601
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City | CHICAGO
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State | IL
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Zip | 60631-2816
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Country | US
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Telephone | 773-644-5535
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Fax | 773-644-5582
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041432733
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209018516
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License Number State | IL
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