Provider Demographics
NPI:1073147989
Name:SULLIVAN, DARRIAN RENEE (DNP)
Entity Type:Individual
Prefix:MRS
First Name:DARRIAN
Middle Name:RENEE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 W 76TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-4728
Mailing Address - Country:US
Mailing Address - Phone:219-689-3199
Mailing Address - Fax:
Practice Address - Street 1:5825 BROADWAY
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-2687
Practice Address - Country:US
Practice Address - Phone:219-689-3199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-29
Last Update Date:2020-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28204072A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily