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General NPI Number Information
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NPI Number | 1588049043
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Entity Type | Individual
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Provider Name | LAUREN MARIE SULLIVAN FNP
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Gender | Female
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Dates
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Enumeration Date | 07/27/2015
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Last Update Date | 05/09/2024
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Provider Practice Location Address
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Address Line | 571 TREVINO RDG
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City | CRESTVIEW HILLS
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State | KY
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Zip | 41017-3486
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Country | US
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Telephone | 859-412-6904
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Fax |
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Provider Business Mailing Address
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Address Line | 571 TREVINO RDG
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City | CRESTVIEW HILLS
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State | KY
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Zip | 41017-3486
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Country | US
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Telephone | 859-412-6904
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3009575
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 025658
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0002351
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License Number State | CO
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