| NPI | 1891016358 |
|---|---|
| Former Name | SHELLY M SULLIVAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2010011279) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 1499522042) |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2014-02-01 |