MEDICARE: RACHEL E SULLIVAN RPSGT, CNA

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	163W00000X	Registered Nurse	357237-3102	UT
2	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1336405190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL E SULLIVAN RPSGT, CNA

Provider Business Mailing Address
First Line	:	3725 W 4100 S STE 201
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-6490
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3737 W 4100 S
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-5543
Country	:	US
Telephone Number	:	888-949-4864
Fax Number	:

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

Provider Enumeration Date	:	04/05/2012
Last Update Date	:	08/04/2025

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