Provider Demographics
NPI:1821335688
Name:SULLIVAN, CATHERINE ANN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:ANN
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14750 MARILYN LN
Mailing Address - Street 2:
Mailing Address - City:PIONEER
Mailing Address - State:CA
Mailing Address - Zip Code:95666-9754
Mailing Address - Country:US
Mailing Address - Phone:209-295-3443
Mailing Address - Fax:
Practice Address - Street 1:12140 NEW YORK RANCH RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-9407
Practice Address - Country:US
Practice Address - Phone:209-257-2400
Practice Address - Fax:209-257-2403
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA431982363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily