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General NPI Number Information
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NPI Number | 1164516670
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Entity Type | Individual
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Provider Name | CHRISTINE SULLIVAN
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Gender | Female
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 02/08/2021
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Provider Practice Location Address
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Address Line | 9900 BREN RD E
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City | MINNETONKA
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State | MN
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Zip | 55343-9664
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Country | US
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Telephone | 516-458-7837
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Fax |
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Provider Business Mailing Address
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Address Line | 79 ALEXANDRA DR
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City | STAMFORD
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State | CT
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Zip | 06903-1731
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Country | US
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Telephone | 516-458-7837
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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 | 335063
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License Number State | NY
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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 | 5266
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License Number State | CT
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