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General NPI Number Information
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NPI Number | 1932153632
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Entity Type | Individual
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Provider Name | JACQUELINE RUTH SULLIVAN-OGG ARNP-BC
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Gender | Female
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 401 HIGHWAY ST
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City | UNDERWOOD
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State | IA
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Zip | 51576
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Country | US
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Telephone | 712-566-9148
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Fax | 712-566-9408
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Provider Business Mailing Address
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Address Line | 401 HIGHWAY ST PO BOX 218
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City | UNDERWOOD
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State | IA
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Zip | 51576-0218
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Country | US
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Telephone | 712-566-9148
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Fax | 712-566-9408
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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 | A-082459
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License Number State | IA
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