Provider Demographics
NPI:1932742400
Name:SULLIVAN, CHRISTINA (DNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:FROEHLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:8219 QUEEN AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55444-1513
Mailing Address - Country:US
Mailing Address - Phone:952-836-9608
Mailing Address - Fax:
Practice Address - Street 1:45 10TH ST W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-1062
Practice Address - Country:US
Practice Address - Phone:651-232-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-28
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6871363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health