Provider Demographics
NPI:1407421647
Name:SULLIVAN, JANET
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:SULLIVAN
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 1:515 N SAM HOUSTON PKWY E STE 215
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-4000
Mailing Address - Country:US
Mailing Address - Phone:832-651-6997
Mailing Address - Fax:281-931-4429
Practice Address - Street 1:515 N SAM HOUSTON PKWY E STE 215
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-4000
Practice Address - Country:US
Practice Address - Phone:832-651-6997
Practice Address - Fax:281-931-4429
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251651163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management