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General NPI Number Information
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NPI Number | 1457670572
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Entity Type | Organization
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Legal Business Name | MEDICAL INNOVATIONS INC
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Dates
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Enumeration Date | 05/28/2010
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Last Update Date | 05/28/2010
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Provider Practice Location Address
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Address Line | 6158 LAKE FRONT DR
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City | FORT MYERS
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State | FL
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Zip | 33908-4432
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Country | US
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Telephone | 239-218-7337
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Fax | 239-432-9546
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Provider Business Mailing Address
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Address Line | 6158 LAKE FRONT DR
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City | FORT MYERS
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State | FL
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Zip | 33908-4432
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Country | US
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Telephone | 239-218-7337
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Fax | 239-432-9546
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Authorized Official
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Title or Position | SOLE OWNER
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Name | MS. DAGMAR SULLIVAN
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Credential | ARNP
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Telephone | 239-218-7337
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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 |
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License Number State |
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