Provider Demographics
NPI:1639298540
Name:SULLIVAN, LINDA (CRNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3632 DAUPHIN ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1247
Mailing Address - Country:US
Mailing Address - Phone:251-460-5280
Mailing Address - Fax:251-460-5339
Practice Address - Street 1:210 GOVERNMENT ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36602-2614
Practice Address - Country:US
Practice Address - Phone:251-433-8448
Practice Address - Fax:251-460-5431
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1024547363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051506120OtherBLUE CROSS
AL009914210Medicaid
AL51108245OtherBLUE CROSS
AL051506120OtherBLUE CROSS
AL51108245OtherBLUE CROSS