Provider Demographics
NPI:1821408550
Name:SULLENBERGER, CHRISTINE (RN)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:
Last Name:SULLENBERGER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DEMUNN RD
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAMS
Mailing Address - State:NY
Mailing Address - Zip Code:14812-9149
Mailing Address - Country:US
Mailing Address - Phone:607-936-6837
Mailing Address - Fax:
Practice Address - Street 1:100 DEMUNN RD
Practice Address - Street 2:
Practice Address - City:BEAVER DAMS
Practice Address - State:NY
Practice Address - Zip Code:14812-9149
Practice Address - Country:US
Practice Address - Phone:607-936-6837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195359-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse