Provider Demographics
NPI:1578976452
Name:SULLIVAN, CHANEE (RNC, BSN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:CHANEE
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:RNC, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 ELMWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-8223
Mailing Address - Country:US
Mailing Address - Phone:252-955-0492
Mailing Address - Fax:
Practice Address - Street 1:3501 ELMWOOD RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-8223
Practice Address - Country:US
Practice Address - Phone:252-955-0492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLC33976163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant