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General NPI Number Information
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NPI Number | 1215904438
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Entity Type | Individual
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Provider Name | ANNATA RAE SULLIVAN RN, APRN
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Gender | Female
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Dates
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Enumeration Date | 03/07/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 697 LOUISIANA DR.
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City | DYESS, AFB
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State | TX
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Zip | 79607-4425
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Country | US
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Telephone | 325-696-3543
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Fax |
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Provider Business Mailing Address
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Address Line | 2917 STONECREST DR
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City | ABILENE
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State | TX
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Zip | 79606-3453
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Country | US
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Telephone | 325-691-5232
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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 | 110470
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License Number State | NE
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