Provider Demographics
NPI:1922305358
Name:SULLENBRAND, KATIE (CNM)
Entity Type:Individual
Prefix:MS
First Name:KATIE
Middle Name:
Last Name:SULLENBRAND
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 CHEROKEE DR NW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52405-2368
Mailing Address - Country:US
Mailing Address - Phone:319-432-5651
Mailing Address - Fax:
Practice Address - Street 1:1525 CHEROKEE DR NW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52405-2368
Practice Address - Country:US
Practice Address - Phone:319-432-5651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAB-114258367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife