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General NPI Number Information
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NPI Number | 1760508329
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Entity Type | Individual
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Provider Name | JULIA W SULLIVAN CRNA
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Gender | Female
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 03/29/2016
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Provider Practice Location Address
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Address Line | 1200 J D ANDERSON DR
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City | MORGANTOWN
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State | WV
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Zip | 26505-3494
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Country | US
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Telephone | 304-346-9400
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Fax | 304-345-7320
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Provider Business Mailing Address
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Address Line | 101 STADIUM DR
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City | MORGANTOWN
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State | WV
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Zip | 26506-7911
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Country | US
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Telephone | 304-346-9400
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Fax | 304-720-8461
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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 | 47812
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License Number State | WV
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