Provider Demographics
NPI:1659894319
Name:SULLIVAN, RAHAB NJERI (LVN)
Entity Type:Individual
Prefix:MRS
First Name:RAHAB
Middle Name:NJERI
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MRS
Other - First Name:RAHAB
Other - Middle Name:NJERI
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LVN
Mailing Address - Street 1:29117 ROSEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-5432
Mailing Address - Country:US
Mailing Address - Phone:909-855-5306
Mailing Address - Fax:
Practice Address - Street 1:29117 ROSEWOOD LN
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-5432
Practice Address - Country:US
Practice Address - Phone:909-855-5306
Practice Address - Fax:909-855-5306
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-24
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN253681164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse