MEDICARE: MS. DEBORAH A SULLIVAN NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	69284	CO

General Provider Information

NPI Number	:	1023018900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBORAH A SULLIVAN NP

Provider Business Mailing Address
First Line	:	2139 N ACADEMY BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1507
Country	:	US
Telephone Number	:	719-550-1172
Fax Number	:	719-591-2864

Provider Business Practice Location Address
First Line	:	2139 N ACADEMY BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1507
Country	:	US
Telephone Number	:	719-550-1172
Fax Number	:	719-591-2864

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	09/24/2007

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