Provider Demographics
NPI:1952419566
Name:SULLIVAN, JEANNETTE M (FNP)
Entity type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:M
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 WINSTON DR
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-8526
Mailing Address - Country:US
Mailing Address - Phone:269-789-4380
Mailing Address - Fax:
Practice Address - Street 1:203 WINSTON DR
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-8526
Practice Address - Country:US
Practice Address - Phone:269-789-4380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704196183363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704196183OtherSTATE LICENSE NUMBER