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General NPI Number Information
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NPI Number | 1336267699
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Entity Type | Individual
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Provider Name | PAMELA SUE SULLIVAN GNP
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Gender | Female
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 40055 BOB HOPE DR STE B
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-3940
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Country | US
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Telephone | 760-202-3946
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Fax | 760-770-4392
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Provider Business Mailing Address
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Address Line | 2160 COLONIAL BLVD
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City | FORT MYERS
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State | FL
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Zip | 33907-1410
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Country | US
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Telephone | 239-931-7342
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Fax | 239-931-7385
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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 | 163WG0600X
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Taxonomy Name | Gerontology Registered Nurse
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License Number | 262478
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 12764
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License Number State | CA
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