Provider Demographics
NPI:1245300631
Name:SULLIVAN, JANICE L (RN)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:L
Last Name:SULLIVAN
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 1:13925 N WARBONNET LN
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-1590
Mailing Address - Country:US
Mailing Address - Phone:928-771-3560
Mailing Address - Fax:928-771-3542
Practice Address - Street 1:6717 E 2ND ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2659
Practice Address - Country:US
Practice Address - Phone:928-771-3560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN080551163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management