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NPI Code Detail

MEDICARE: ASHATE RENEE SULLIVAN LPN

MEDICARE: ASHATE RENEE SULLIVAN LPN
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
1164W00000XLicensed Practical Nurse188712OH

General Provider Information

NPI Number : 1275365165
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHATE RENEE SULLIVAN LPN
Provider Business Mailing Address
First Line : 24480 UPPINGHAM RD
Second Line :
City : BEDFORD HEIGHTS
State : OH
Zip : 44146-4072
Country : US
Telephone Number : 216-548-1808
Fax Number :
Provider Business Practice Location Address
First Line : 1275 LAKESIDE AVE E
Second Line :
City : CLEVELAND
State : OH
Zip : 44114-1129
Country : US
Telephone Number : 216-548-1808
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2024
Last Update Date : 08/19/2024

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