Provider Demographics
NPI:1417679275
Name:SULLIVAN, AMBER I
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:I
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:PO BOX 3597
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-3597
Mailing Address - Country:US
Mailing Address - Phone:907-952-1168
Mailing Address - Fax:907-802-6100
Practice Address - Street 1:2529 CURLEW CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-1654
Practice Address - Country:US
Practice Address - Phone:907-952-1168
Practice Address - Fax:907-802-6100
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies