1427353598 NPI number — MS. CHERYL A SULLIVAN FNP

Table of content: MS. CHERYL A SULLIVAN FNP (NPI 1427353598)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427353598 NPI number — MS. CHERYL A SULLIVAN FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SULLIVAN
Provider First Name:
CHERYL
Provider Middle Name:
A
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WENDELL
Provider Other First Name:
CHERYL
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1427353598
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
707 N LOGAN AVE
Provider Second Line Business Mailing Address:
DANVILLE POLYCLINIC, LTD.
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61832-4360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-477-4784
Provider Business Mailing Address Fax Number:
217-477-4704

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
707 N LOGAN AVE
Provider Second Line Business Practice Location Address:
DANVILLE POLYCLINIC, LTD.
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61832-4360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-477-4784
Provider Business Practice Location Address Fax Number:
217-477-4704
Provider Enumeration Date:
01/20/2011

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: 363LF0000X , with the licence number:  209008516 , 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)

  • Identifier: 201080250 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com