Provider Demographics
NPI:1750449344
Name:SULLIVAN, MARI CATHERINE (MSN, ARNP-C)
Entity Type:Individual
Prefix:MS
First Name:MARI
Middle Name:CATHERINE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MSN, ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4210 KUALA LUMPUR PL
Mailing Address - Street 2:
Mailing Address - City:DULLES
Mailing Address - State:VA
Mailing Address - Zip Code:20189-4210
Mailing Address - Country:US
Mailing Address - Phone:202-663-2453
Mailing Address - Fax:
Practice Address - Street 1:DEPT OF STATE SA-1 MED QI
Practice Address - Street 2:2401 E STREET NW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20522-0102
Practice Address - Country:US
Practice Address - Phone:202-663-2453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP300001946363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily