MEDICARE: JULIE DIANNE SULLIVAN

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	246ZC0007X	Surgical Assistant

General Provider Information

NPI Number	:	1063889509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE DIANNE SULLIVAN

Provider Business Mailing Address
First Line	:	3645 S ALBERTA PL
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85730-3201
Country	:	US
Telephone Number	:	520-664-5010
Fax Number	:

Provider Business Practice Location Address
First Line	:	5301 E GRANT RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-2805
Country	:	US
Telephone Number	:	520-327-5461
Fax Number	:

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

Provider Enumeration Date	:	09/01/2015
Last Update Date	:	02/10/2026

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Directions to “ JULIE DIANNE SULLIVAN ” Practice Location

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