Provider Demographics
NPI:1235825548
Name:SULLIVAN, EMILY ELIZABETH (APRN-CRNA DNP)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:ELIZABETH
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:APRN-CRNA DNP
Other - Prefix:MISS
Other - First Name:EMILY
Other - Middle Name:ELIZABETH
Other - Last Name:KIRKHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:896 OAK DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-8468
Mailing Address - Country:US
Mailing Address - Phone:740-341-2655
Mailing Address - Fax:
Practice Address - Street 1:5030 BRUNSON DR
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2412
Practice Address - Country:US
Practice Address - Phone:305-284-3666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.438474163W00000X
FL390200000X
MI4704410275367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program