Provider Demographics
NPI:1669791158
Name:SULLIVAN, SARA LAUREN KIEHN (FNP)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:LAUREN KIEHN
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:SARA
Other - Middle Name:LAUREN
Other - Last Name:KIEHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 240
Mailing Address - Street 2:
Mailing Address - City:POINT REYES STATION
Mailing Address - State:CA
Mailing Address - Zip Code:94956-0240
Mailing Address - Country:US
Mailing Address - Phone:415-663-1082
Mailing Address - Fax:415-663-9474
Practice Address - Street 1:2927 CARLSON BLVD
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-3511
Practice Address - Country:US
Practice Address - Phone:510-559-9408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-23
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19617363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily