Provider Demographics
NPI:1265495857
Name:SULLIVAN, SEAN PATRICK (RN)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:PATRICK
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 N 83RD ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-1805
Mailing Address - Country:US
Mailing Address - Phone:414-379-4748
Mailing Address - Fax:414-461-8772
Practice Address - Street 1:141 LAKESHORE DR
Practice Address - Street 2:UNIT A6
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-9653
Practice Address - Country:US
Practice Address - Phone:262-552-0229
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse