Provider Demographics
NPI:1265063531
Name:SULLIVAN, RACHELLE (APRN- FNP-BC)
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:APRN- FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 E 3100 S
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-1385
Mailing Address - Country:US
Mailing Address - Phone:435-680-1154
Mailing Address - Fax:
Practice Address - Street 1:3301 E 3100 S
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-1385
Practice Address - Country:US
Practice Address - Phone:435-680-1154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV828362363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily