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General NPI Number Information
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NPI Number | 1245538669
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Entity Type | Individual
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Provider Name | KEVIN JOHN SULLIVAN CRNA
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Gender | Male
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Dates
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Enumeration Date | 03/09/2011
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Last Update Date | 03/12/2020
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Provider Practice Location Address
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Address Line | 280 PALE SAN VITORES RD
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City | TAMUNING
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State | GU
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Zip | 96913-3615
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Country | US
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Telephone | 671-647-4542
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Fax |
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Provider Business Mailing Address
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Address Line | 369 FARENHOLT AVE
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City | TAMUNING
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State | GU
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Zip | 96913-3106
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Country | US
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Telephone | 671-787-8627
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | CRNA000407
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | ARNP9237910
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | NP0152
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License Number State | GU
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