Provider Demographics
NPI:1750449344
Name:SULLIVAN, MARI CATHERINE (DNP, MSN, ARNP-C)
Entity type:Individual
Prefix:DR
First Name:MARI
Middle Name:CATHERINE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:DNP, MSN, ARNP-C
Other - Prefix:DR
Other - First Name:MARI
Other - Middle Name:CATHERINE
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP, MSN, ARNP
Mailing Address - Street 1:32020 LITTLE BOSTON RD NE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:WA
Mailing Address - Zip Code:98346-9734
Mailing Address - Country:US
Mailing Address - Phone:360-297-2840
Mailing Address - Fax:360-925-3897
Practice Address - Street 1:PORT GAMBLE S'KLALLAM TRIBE COMMUNITY HEALTH
Practice Address - Street 2:32020 LITTLE BOSTON RD NE
Practice Address - City:KINGSTON
Practice Address - State:WA
Practice Address - Zip Code:98346
Practice Address - Country:US
Practice Address - Phone:360-297-2840
Practice Address - Fax:360-925-3897
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP300001946363LF0000X
WAAP30001946207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily