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General NPI Number Information
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NPI Number | 1568901544
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Entity Type | Individual
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Provider Name | STEPHANIE ANN SULLIVAN D.N.P., C.R.N.A.
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Gender | Female
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Dates
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Enumeration Date | 02/23/2017
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Last Update Date | 02/23/2017
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Provider Practice Location Address
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Address Line | UNITY POINT HEALTH METHODIST 221 NE GLEN OAK AVENUE
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City | PEORIA
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State | IL
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Zip | 61636-0001
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Country | US
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Telephone | 309-672-5522
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Fax |
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Provider Business Mailing Address
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Address Line | 2305 W MADERA CT
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City | PEORIA
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State | IL
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Zip | 61614-1445
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Country | US
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Telephone | 309-360-5827
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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 | 209.015654
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License Number State | IL
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