Provider Demographics
NPI:1649495821
Name:SULLIVAN, SHAWN MARIE (ARNP)
Entity type:Individual
Prefix:MS
First Name:SHAWN
Middle Name:MARIE
Last Name:SULLIVAN
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Gender:F
Credentials:ARNP
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Mailing Address - Street 1:804 SERVICE RD STE A109B
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-353-4911
Mailing Address - Fax:517-432-3928
Practice Address - Street 1:1215 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1811
Practice Address - Country:US
Practice Address - Phone:517-884-8701
Practice Address - Fax:517-884-8787
Is Sole Proprietor?:No
Enumeration Date:2007-04-14
Last Update Date:2023-06-21
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Provider Licenses
StateLicense IDTaxonomies
FLFL1997192363LN0000X
FL1997192363LN0000X
MI4704368871363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal