Provider Demographics
NPI:1558562553
Name:SULLIVAN, KAY ELLEN (MS APN)
Entity Type:Individual
Prefix:MRS
First Name:KAY
Middle Name:ELLEN
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MS APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:592 GLENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-8878
Mailing Address - Country:US
Mailing Address - Phone:219-759-4276
Mailing Address - Fax:
Practice Address - Street 1:215 BROADWAY
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46402-1221
Practice Address - Country:US
Practice Address - Phone:219-888-5975
Practice Address - Fax:219-888-4197
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000500A163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0106XNursing Service ProvidersRegistered NurseOccupational Health