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General NPI Number Information
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NPI Number | 1033752530
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Entity Type | Individual
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Provider Name | CRYSTAL JEAN SULLIVAN FNP
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Gender | Female
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Dates
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Enumeration Date | 10/28/2019
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Last Update Date | 09/24/2025
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Provider Practice Location Address
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Address Line | 193 24TH ST E STE 102
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City | DICKINSON
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State | ND
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Zip | 58601-6580
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Country | US
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Telephone | 701-225-3536
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Fax |
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Provider Business Mailing Address
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Address Line | 1768 YELLOWSTONE CIR
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City | DICKINSON
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State | ND
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Zip | 58601-3002
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Country | US
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Telephone | 701-590-2549
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN.0995068-NP
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License Number State | CO
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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 | R48527
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License Number State | ND
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