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1023045200
LAVERNE A SULLIVAN
FORT WAYNE, IN
NPI
1023045200
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
133V00000X Dietitian, Registered
(Licence: IN 37000748A)
Enumeration Date
2006-06-26
Last Update Date
2014-07-01
Business Address
LAVERNE A SULLIVAN RD
4210 FLAGSTAFF CV
FORT WAYNE, IN 46815-4417
Phone number: 260-489-9009
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Mailing Address
LAVERNE A SULLIVAN RD
5244 JEFFRIES LANE
NEWBURGH, IN 47630
Phone number: 812-454-1710
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