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General NPI Number Information
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NPI Number | 1225115652
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Entity Type | Individual
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Provider Name | MARCIA SULLIVAN NP
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Gender | Female
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 05/25/2011
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Provider Practice Location Address
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Address Line | 3056 S KINNICKINNIC AVE
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City | MILWAUKEE
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State | WI
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Zip | 53207-2521
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Country | US
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Telephone | 414-769-4900
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Fax |
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Provider Business Mailing Address
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Address Line | 4425 N PORT WASHINGTON RD ATTN: CLINIC CREDENTIALING
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City | GLENDALE
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State | WI
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Zip | 53212-1082
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Country | US
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Telephone | 414-769-4900
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 935
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License Number State | WI
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