Provider Demographics
NPI:1275926180
Name:SULLINS, ERICKA JEAN
Entity Type:Individual
Prefix:MRS
First Name:ERICKA
Middle Name:JEAN
Last Name:SULLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 N GARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-3805
Mailing Address - Country:US
Mailing Address - Phone:520-249-4349
Mailing Address - Fax:
Practice Address - Street 1:75 N GARDEN AVE
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-3805
Practice Address - Country:US
Practice Address - Phone:520-459-9929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist