1316905938 NPI number — COLLEEN P SULLIVAN MSN CS C AP MHCNS AP

Table of content: COLLEEN P SULLIVAN MSN CS C AP MHCNS AP (NPI 1316905938)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316905938 NPI number — COLLEEN P SULLIVAN MSN CS C AP MHCNS AP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SULLIVAN
Provider First Name:
COLLEEN
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN CS C AP MHCNS AP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SULLIVAN-RUSSO
Provider Other First Name:
COLLEEN
Provider Other Middle Name:
PATRICIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CS CA P MHCNS CS A
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1316905938
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
329 NW ROCKHILL LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEES SUMMIT
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64081
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-525-9787
Provider Business Mailing Address Fax Number:
816-525-1191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10918 ELM AVENUE
Provider Second Line Business Practice Location Address:
CRITTENTON CHILDRENS CENTER
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-765-6600
Provider Business Practice Location Address Fax Number:
816-767-4159
Provider Enumeration Date:
05/03/2006

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: 363LP0808X , with the licence number:  1405842052 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 097147 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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