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General NPI Number Information
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NPI Number | 1801639976
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Entity Type | Individual
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Provider Name | DANIELLE NICOLE SULLIVAN
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Gender | Female
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Dates
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Enumeration Date | 06/17/2024
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Last Update Date | 04/15/2026
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Provider Practice Location Address
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Address Line | 414 5TH AVE
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City | ALBANY
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State | GA
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Zip | 31701-1976
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Country | US
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Telephone | 229-883-4555
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Fax | 229-888-0063
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Provider Business Mailing Address
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Address Line | 414 5TH AVE
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City | ALBANY
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State | GA
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Zip | 31701-1976
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Country | US
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Telephone | 229-883-4555
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Fax | 229-888-0063
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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 | GA339973
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN9565528
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License Number State | FL
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