Provider Demographics
NPI:1710114376
Name:SULLIVAN, NANCY MARIE (DO)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:MARIE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 UNIVERSITY AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-5945
Mailing Address - Country:US
Mailing Address - Phone:515-401-1950
Mailing Address - Fax:
Practice Address - Street 1:4200 UNIVERSITY AVE STE 300
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-5945
Practice Address - Country:US
Practice Address - Phone:515-401-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADO-04705207L00000X
NC2014-00218207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology