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General NPI Number Information
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NPI Number | 1740360353
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Entity Type | Individual
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Provider Name | WANDA J SULLIVAN RN
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Gender | Female
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 02/18/2016
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Provider Practice Location Address
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Address Line | 765 S BONNER ST
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City | RUSTON
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State | LA
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Zip | 71270-5801
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Country | US
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Telephone | 318-202-5935
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Fax | 318-202-5933
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Provider Business Mailing Address
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Address Line | PO BOX 1839
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City | RUSTON
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State | LA
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Zip | 71273-1839
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Country | US
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Telephone | 318-202-5935
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Fax | 318-202-5933
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN073140
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License Number State | LA
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