| NPI | 1104047265 |
|---|---|
| Former Name | TARA LYNN SULLIVAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: NM MD2011-0413) |
| Additional Taxonomies | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: TX M8636) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2021-10-21 |