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General NPI Number Information
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NPI Number | 1730121864
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Entity Type | Individual
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Provider Name | STEPHANIE M. SULLIVAN MSN, NP
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Gender | Female
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 01/11/2022
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Provider Practice Location Address
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Address Line | 2001 DWIGHT WAY SECOND FLOOR
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City | BERKELEY
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State | CA
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Zip | 94704-2608
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Country | US
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Telephone | 510-204-5770
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Fax | 510-204-5749
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Provider Business Mailing Address
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Address Line | 2001 DWIGHT WAY SECOND FLOOR
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City | BERKELEY
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State | CA
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Zip | 94704-2608
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Country | US
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Telephone | 510-204-5770
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Fax | 510-204-5749
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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 | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number | 566514
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License Number State | CA
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