Provider Demographics
NPI:1770723603
Name:SULLIVAN, MELANIE PRINCE (CRNP)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:PRINCE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:CHIPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:PO BOX 2705
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35804-2705
Mailing Address - Country:US
Mailing Address - Phone:256-265-5833
Mailing Address - Fax:
Practice Address - Street 1:910 ADAMS ST SE STE 310
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801
Practice Address - Country:US
Practice Address - Phone:256-265-5833
Practice Address - Fax:256-265-5834
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-156986363LF0000X
TN14030363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily