Provider Demographics
NPI:1255099230
Name:SULLIVAN, LINDSAY NICOLE (RN)
Entity type:Individual
Prefix:MS
First Name:LINDSAY
Middle Name:NICOLE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:LINDSAY
Other - Middle Name:NICOLE
Other - Last Name:PERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:254 NORMAN DR NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-1423
Mailing Address - Country:US
Mailing Address - Phone:319-360-9536
Mailing Address - Fax:
Practice Address - Street 1:254 NORMAN DR NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-1423
Practice Address - Country:US
Practice Address - Phone:319-360-9536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA111318163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health