| NPI | 1316905938 |
|---|---|
| Other Name | COLLEEN PATRICIA SULLIVAN-RUSSO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: MO 097147) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: KS 1405842052) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2007-07-08 |