Provider Demographics
NPI:1326242231
Name:SULLIVAN, ERIKA JEAN (LAC)
Entity Type:Individual
Prefix:MS
First Name:ERIKA
Middle Name:JEAN
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1074 ROBERT ST S
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-1457
Mailing Address - Country:US
Mailing Address - Phone:651-769-5228
Mailing Address - Fax:
Practice Address - Street 1:1074 ROBERT ST S
Practice Address - Street 2:
Practice Address - City:WEST SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-1457
Practice Address - Country:US
Practice Address - Phone:651-769-5228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1383171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist