Provider Demographics
NPI:1538504519
Name:O'SULLIVAN, EILEEN (MB BCH BAO)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:
Last Name:O'SULLIVAN
Suffix:
Gender:F
Credentials:MB BCH BAO
Other - Prefix:DR
Other - First Name:EILEEN
Other - Middle Name:
Other - Last Name:O'SULLIVAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MB BCH BAO
Mailing Address - Street 1:PO BOX 4825
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4825
Mailing Address - Country:US
Mailing Address - Phone:360-882-2778
Mailing Address - Fax:
Practice Address - Street 1:2529 NE 139TH ST STE 110
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-2719
Practice Address - Country:US
Practice Address - Phone:360-882-2778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD192455207P00000X, 207P00000X
WAMD61237966207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine