1073382032 NPI number — SULLIVAN WASKOSKY APRN, CNM

Table of content: SULLIVAN WASKOSKY APRN, CNM (NPI 1073382032)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073382032 NPI number — SULLIVAN WASKOSKY APRN, CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WASKOSKY
Provider First Name:
SULLIVAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN, CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073382032
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
MEADOW PROGRAM, VUSN 461 21ST AVE S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-343-2683
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
611 W PARK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
URBANA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61801-2501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-383-3311
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/01/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367A00000X , with the licence number:  209032525 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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