Provider Demographics
NPI:1518362912
Name:SULLIVAN, CHRISTINA
Entity Type:Individual
Prefix:
First Name:CHRISTINA
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 1:13114 FM 1960 RD W
Mailing Address - Street 2:114
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-4290
Mailing Address - Country:US
Mailing Address - Phone:281-469-2838
Mailing Address - Fax:281-469-9314
Practice Address - Street 1:13114 FM 1960 RD W
Practice Address - Street 2:114
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-4290
Practice Address - Country:US
Practice Address - Phone:281-469-2838
Practice Address - Fax:281-469-9314
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126313363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics