Provider Demographics
NPI:1497991582
Name:SULLIVAN, MOLLIE FRANCES (LM, CPM)
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:FRANCES
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-1625
Mailing Address - Country:US
Mailing Address - Phone:510-710-7166
Mailing Address - Fax:510-482-1511
Practice Address - Street 1:3801 LINWOOD AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-1625
Practice Address - Country:US
Practice Address - Phone:510-710-7166
Practice Address - Fax:510-482-1511
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-19
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife