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General NPI Number Information
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NPI Number | 1447169057
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Entity Type | Individual
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Provider Name | ANNALIESA SULLIVAN DC
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Gender | Female
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Dates
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Enumeration Date | 09/02/2026
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Last Update Date | 09/02/2026
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Provider Practice Location Address
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Address Line | 219 E PINE ST APT 110
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City | PINEDALE
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State | WY
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Zip | 82941-5316
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Country | US
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Telephone | 307-336-8021
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 128
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City | DANIEL
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State | WY
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Zip | 83115-0128
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Country | US
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Telephone |
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 887
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License Number State | WY
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