Provider Demographics
NPI:1518614288
Name:SULLIVAN, ROBIN L (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:L
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 N COURT ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103-6862
Mailing Address - Country:US
Mailing Address - Phone:815-720-4000
Mailing Address - Fax:
Practice Address - Street 1:555 N COURT ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103-6862
Practice Address - Country:US
Practice Address - Phone:847-720-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209024839363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily