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1730775495
SAMUEL SULLIVAN
SALEM, OR
NPI
1730775495
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
164W00000X Licensed Practical Nurse
(Licence: OR 202007792LPN)
Enumeration Date
2020-12-16
Last Update Date
2020-12-16
Business Address
SAMUEL SULLIVAN
1750 MCGILCHRIST ST SE STE 130
SALEM, OR 97302-1691
Phone number: 971-304-2200
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Mailing Address
SAMUEL SULLIVAN
1332 LYDIA AVE N
KEIZER, OR 97303-7550
Phone number: 516-860-7294
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