Provider Demographics
NPI:1669803805
Name:SULLIVAN, KRISPIN N (MS, CN, RN)
Entity type:Individual
Prefix:MS
First Name:KRISPIN
Middle Name:N
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MS, CN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:938 WENDY LN
Mailing Address - Street 2:UNIT B
Mailing Address - City:INCLINE VILLAGE
Mailing Address - State:NV
Mailing Address - Zip Code:89451-9009
Mailing Address - Country:US
Mailing Address - Phone:775-831-0292
Mailing Address - Fax:775-996-0204
Practice Address - Street 1:938 WENDY LN
Practice Address - Street 2:UNIT B
Practice Address - City:INCLINE VILLAGE
Practice Address - State:NV
Practice Address - Zip Code:89451-9009
Practice Address - Country:US
Practice Address - Phone:775-831-0292
Practice Address - Fax:775-996-0204
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education