Provider Demographics
NPI:1235371592
Name:SULLIVAN, AMBER (ND, LAC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E JEFFERSON ST STE 603
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5649
Mailing Address - Country:US
Mailing Address - Phone:206-726-0034
Mailing Address - Fax:206-726-9434
Practice Address - Street 1:1600 E JEFFERSON ST STE 603
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122
Practice Address - Country:US
Practice Address - Phone:206-726-0034
Practice Address - Fax:206-726-9434
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002987171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist