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1770139123
STAYCE K SULLIVAN
SAN RAFAEL, CA
NPI
1770139123
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363LA2100X Nurse Practitioner Acute Care
(Licence: CA 95012073)
Enumeration Date
2019-08-12
Last Update Date
2019-08-12
Business Address
STAYCE K SULLIVAN
515 NORTHGATE DR. STE. 101
SAN RAFAEL, CA 94903-9490
Phone number: 415-202-9990
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Mailing Address
STAYCE K SULLIVAN
42 GRANDE PASEO
SAN RAFAEL, CA 94903-1546
Phone number: 509-995-7310
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