Provider Demographics
NPI:1922713437
Name:SUNFLOWER MOBILE & MEDICAL CLINIC LLC
Entity Type:Organization
Organization Name:SUNFLOWER MOBILE & MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:505-920-5180
Mailing Address - Street 1:955 RICHARDS AVE APT 2047
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-6217
Mailing Address - Country:US
Mailing Address - Phone:813-484-2335
Mailing Address - Fax:
Practice Address - Street 1:1533 S SAINT FRANCIS DR STE A
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4032
Practice Address - Country:US
Practice Address - Phone:813-484-2335
Practice Address - Fax:949-404-8999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-18
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty